■J  V;^:,r.: 


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in  tfie€itp  of  M 

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Columbia  Mnibersiitp  *  Uc>. 
in  tijeCitp  of  jaeto^orlt  ^    ^ 


l^efereiice  Eibrarp 


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ORTHODONTIA, 


OR 


MALPOSITION  OF  THE  HUMAN  TEETH 
ITS  PREVENTION  AND  REMEDY. 


BY 

S.  H.  GUILFORD,  A.M.,  D.D.S.,  Ph.D., 

Professor  op  Operative  and  Prosthetic  Dentistry  in  the  Philadelphia  Dental 
College;   Author  o^  "Nitrous  Oxide,"  &c. 


Approved   by   the    National  Association   of    Dental    Faculties   as  a  text 
book  for   use  in  the  schools   of   its   representation. 


SECOND   EDITION,  EEVISED   AND   ENLAEGED. 


PHILADELPHIA  : 
PRESS  OF  SPANGLER  &   DAVIS, 

529  COMMERCE  STREET. 


Entered  accordicg  to  Act  of  Congress,  in  the  year  1893,  by 

S.  H.  GUILFORD, 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


To  MY 

fei.low-teachees 

of  this  special  branch  of 

Dental  Science  and  to  the  many 

pupils  whom   it  has  been  my  pleasure  to 

instruct,  this  second  edition  is  respectfully  inscribed. 


Preface  to  First  Edition. 


This  work  has  been  written  at  the  request  of  the  Na- 
tional Association  of  Dental  Faculties  in  furtherance  of  its 
plan  to  secure  the  preparation  of  a  series  of  text-books  for 
use  in  American  Dental  Colleges.  After  its  completion  and 
examination,  it  was  accepted  and  endorsed  by  the  Asso- 
ciation at  its  meeting  in  Saratoga,  August,  1889. 

The  impartment  of  instruction  in  the  simplest  and  most 
direct  manner  being  the  true  province  of  a  text-book,  the 
author  has  endeavored  in  the  preparation  of  this  work  to 
treat  the  subject  as  concisely  as  possible,  and  to  clothe  his 
thoughts  and  those  of  others  in  such  language  as  to  be 
readily  comprehended  by  beginners  as  well  as  those  some- 
what advanced  in  this  branch  of  study. 

In  the  treatment  of  the  subject,  the  aim  has  been  to  lead 
the  student  step  by  step  from  the  simplest  beginnings  to 
the  more  complicated  and  difficult  work  of  practical  treat- 
ment. To  this  end,  the  underlying  principles  of  the  art  are 
first  elucidated,  after  which  the  principal  methods  employed 
are  explained,  and  lastly,  the  correlation  of  principles  and 
methods  is  shown  in  their  practical  application  to  typical 
cases.  In  Part  III,  the  different  forms  of  irregularity, 
together  with  a  variety  of  plans  for  their  correction,  are 
arranged  under  such  headings  and  in  such  order  as  to  be 
readily  referred  to  in  seeking  aid  for  cases  that  occur  in 
office  practice. 


Vi  PREFACE. 

Should  the  work  fulfill  the  object  aimed  at  in  its  prepa- 
ration, the  author  will  feel  amply  repaid. 

Credit  for  assistance  is  most  cheerfully  given  to  the 
twenty-five  teachers  of  this  branch  in  American  Dental 
Colleges  who  have  read  this  work  in  manuscript,  and  by 
friendly  criticism  and  valuable  suggestions  added  much  to 
its  completeness. 

The  author  would  also  acknowledge  his  indebtedness  to 
Prof.  W.  F.  Litch  for  valuable  services,  and  to  the  S.  S. 
White  Co. ;  Lea,  Brothers  &  Co. ;  P.  Blakiston,  Son  &  Co. ; 
and  other  publishers  and  authors  for  the  use  of  certain  cuts. 

S.  H.  G. 
Philadelphia,  Sept.,  1889. 


Preface  to  Second  Edition. 


The  exhaustion  of  the  first  edition  of  this  work  within 
three  years,  conjoined  with  assurances  of  appreciation  re- 
ceived from  teachers  of  this  branch  in  many  dental  colleges, 
and  its  selection  for  translation  into  French,  and  publication 
first  in  serial  and  later  in  book  form  by  the  editor  of  Le 
Progres  Dentaire,  leads  the  author  to  believe  that  the  work 
has  fulfilled  its  mission  and  been  of  service  to  those  engaged 
in  this  line  of  study. 

In  the  preparation  of  the  present  edition  it  has  been  the 
aim  of  the  author  to  bring  it  fully  up  to  the  present  state 
of  knowledge  in  this  rapidly-advancing  specialty,  to  do 
which  it  has  been  found  necessary  to  rewrite  almost  the 
entire  work  and  enlarge  it  by  more  than  forty  pages.  Each 
chapter  has  been  emended  so  as  to  exclude  such  methods 
of  treatment  as  were  found  to  be  of  lesser  value  and  to 
include  in  their  stead  others  that  are  newer  and  of  greater 
practical  importance.  Some  thirty  of  the  former  illustra- 
tions have  been  discarded,  and  more  than  fifty  new  ones 
introduced  to  make  clearer  the  meaning  of  the  text. 

Two  new  chapters  have  been  added ;  one  on  the  "  Con- 
struction of  Appliances  "  and  another  on  "  Electro-Plating." 
The  former,  fully  illustrated,  is  designed  to  instruct  and 
assist  the  student  in  the  construction  of  the  various  appli- 
ances mentioned  throughout  the  work,  and  the  latter,  to 
-enable  him  to  impart  to  the  devices  made  of  baser  metals 

vii 


Vlll  PREFACE. 

a  more  sightly  apj)earance  and  purer  surface.  These  chap- 
ters, with  part  of  Chapter  X,  Part  III,  of  the  former  edition 
have  been  combined  to  form  Part  IV.  of  the  present  one. 

The  author  desires  to  express  his  indebtedness  to  many 
co-laborers  in  this  branch  for  valuable  suggestions,  and 
especially  to  Professors  C.  L.  Goddard,  of  San  Francisco,  A. 
E.  Matteson  and  C.  S.  Case,  of  Chicago,  E.  H.  Angle,  of 
Minneapolis,  and  Dr.  V.  E.  Jackson,  of  New  York,  for  the 
loan  of  models  and  appliances  and  the  description  of  cases. 

Acknowledgment  is  also  due  the  S.  S.  White  Dent.  Mfg. 
Co.,  Wilmington  Dent.  Co.,  H.  D.  Justi  &  Son  and  other 
publishers  for  their  kindness  in  permitting  the  reproduction 
of  many  illustrations. 

S.  H.  G. 
Philadelphia,  March,  1893. 


CONTENTS 


PART  I. 
PRINCIPLES  INVOLVED. 

Chapter  I. 

PAGE. 

Eegulakity  and  Iekegularity  Defined,        ....  9 

Chapter  II. 

ETIOLOGY. 

Heredity — Long  Retention  of  Deciduous  Teeth — Eakly 
Extraction  of  Deciduous  Teeth— Injudicious  Extrac- 
tion— Delayed  Eruption — Supernumerary  Teeth — 
Accidents — Adenoid  Vegetations — Habits — Superior 
Protrusion — Prognathism — V-Arch — Saddle-Arch,       .  12 

Chapter  III. 

EVILS  ASSOCIATED  WITH  IRREGULAEITY. 

Appearance  Marred — Speech  Affected — Mastication  Im- 
paired— Caries  Induced,  29 

Chapter  IV. 

ADVISABILITY  OF  CORRECTION. 

Age — Health — Sex — Power      of      Appreciation — Family 

Type — Improvement  of  Occlusion,  ....  32 


IX 


X  CONTENTS. 

Chapter  V. 

AGE  AT  WHICH  CORRECTION  MAY  BE  BEGUN. 
Early  Intebfekence — When  Justifiable  and  Advisable — 

When  Correction  should  be  Delayed,  ...  37 

Chapter  VI. 

MOVEMENTS  TO  BE  PRODUCED. 

Principles  Governing  Application  of  Force — Rules  as  to 

SAME, 42 

Chapter  VII. 

EXTRACTION  AS  RELA.TED  TO  ORTHODONTIA. 
Rules  Governing  same, 48 

Chapter  VIII. 

PHYSIOLOGY  OF  TOOTH-MOVEMENT. 

Character  of  Tissues  Involved — The  Alveolar  Process — 
The  Teeth — The  Pulp — The  Pericementum— I'hysio- 
LOGiCAL  Action  in  Movement  of  Teeth,         ...  56 


PART  II. 
MATERIALS  AND  METHODS. 

Chapter  I. 

Examination  of  Mouth — Impression  and  Articulation — 

Study  of  Case  prom  Articulated  Models,    ...  64 

Chapter  II. 

APPLIANCES. 
Materials    and    their    Uses — Qualities    an    Appliance 

should  Possess — Retaining  Appliances,         ...  75 


CONTENTS. 

Chapter  III. 

CONSIDERATION  OF  METHODS. 

Farrae's— Patrick's — Byrnes' — Magill    Band — Angle's — 
Coffin's — Jackson's, 


XI 


90 


PART  III. 


SPECIFIC  FORMS  OF  IRREGULARITY  AND  THEIR  TREAT- 
MENT,       117 

Chap.         I.     Incisor  Teeth   Erupting  Outside  or   inside 
OF    Aech.      Methods    of    Prevention    and 

Correction, 118 

"  II.     Delayed    or    Mal-Eruption    of    Permanent 

Cuspids, 125 

"  III.     Incisor  Teeth  Situated  Outside  or  Inside  of 

Arch  after  Dentition  is  Complete — Cases 
Illustrating   Condition   and    Treatment,  128 

"  IV.    Cuspid  Teeth  Situated  Outside  or  Inside  of 

Arch — Cases  and  Treatment,       .        .        .  138 

"  V.     Misplaced  Bicuspids, 151 

"  VI.    Torsion— Double  Torsion,         ....  157 

"         VII.     Contraction  of  Arch, 167 

"       VIII.     Protrusion  of  Upper  Jaw,        ....  175 

"  IX.     Protrusion  of  Lower  Jaw  or  Prognathism — 

Allen's      Device — Kingsley's  —  Winner's 

Case — Author's, 188 

X.    Lack  OF  Anterior  Occlusion — Various  Plans 

FOR  Treatment, 194 


Xll  CONTENTS. 

PART  IV. 

Chap.        I.     Crowded  Lower  Incisoks,  ....  197 

"  II.     EEorcTioN  OP   Elongation   of  the  Anterior 

Teeth, 201 

"         III.     Assisted    Eruption  of  the  Anterior  Teeth,  204 

"         IV.     Tooth-Shaping, 208 

"  V.     Construction   of    Eegulating    Appliances — 

Description  and  Illustration  of  Tools  and 
Appliances— Ferrules  or  Bands — Eound 
Tubing — Square  Tubing — Wire  Drawing — 
Soft  Soldering — Hard  Soldering — Screws 
AND  Nuts — Comparative  Table  op  Gauges.  211 

Chap.     VI.     ELECTEO-GILDING. 

Cleansing  Baths — Copper  Solution — Gold 
Solution — Battery— Plating,         .        .        .  223 


ORTHODONTIA. 


PART  I.    PRINCIPLES  INVOLVED. 


CHAPTER  I. 


DEFINITION    OF    SUBJECT. 


Orthodontia,  from  ofj/^o^,  straight,  and  o^ouc,  a  tooth,  is 
that  branch  of  dental  practice  which  relates  to  the  correction 
of  irregularity  of  position  of  the  human  teeth. 

Its  recognition  as  a  distinct  branch  or  specialty  of  gen- 
eral dental  practice  has  come  about  in  recent  years,  indeed, 
it  attracted  so  little  attention  less  than  a  century  ago  that 
many  of  the  writers  of  that  day  entirely  omitted  it  from  their 
books  and  writings,  while  those  who  did  refer  to  it,  gave  it 
but  little  attention  and  space.  Whether  the  condition  of 
irregularity  was  less  frequently  met  with  then  than  now  we 
cannot  certainly  tell,  but  inasmuch  as  dentistry  was  then  in 
its  infancy,  and  as  the  most  pressing  demands  upon  the 
dentist  of  that  day  were  for  the  alleviation  of  pain,  the  sub- 
stitution of  artificial  dentures  to  replace  lost  naembers,  and 
the  checking  of  the  ravages  of  decay  by  filling,  it  is  but 
natural  to  suppose  that  there  was  little  time  or  inclination 
to  attempt  the  relief  of  so  apparently  unimportant  a  condi- 
tion as  mere  irregularity  of  position.  Since  then,  however, 
with  the  natural  growth  of  dental  science  and  the  enlarge- 
ment of  its  sphere,  the  subject  of  orthodontia  has  grown  in 

9 


10  ORTHODONTIA. 

importance  until  to-day  it  is  engaging  the  attention  of  some 
of  the  best  minds  in  the  profession  and  forms  an  important 
part  of  the  study  of  every  dental  student. 

With  the  growth  of  its  interest  and  importance,  there  has 
been  a  corresponding  advance  in  investigation  as  to  the 
cause  and  frequency  of  irregularities,  a  more  exact  micro- 
scopical examination  of  the  tissues  concerned  and  of  the 
physiological  changes  occurring  in  them  in  the  process  of 
correcting  such  conditions ;  progress  has  also  been  marked 
by  the  invention  of  a  multiplicity  of  devices  and  appliances 
for  the  more  perfect  and  easy  correction  of  this  class  of 
deformities. 

REGULARITY    AND    IRREGULARITY    DEFINED. 

The  teeth  of  man  when  normally  placed  in  the  alveolar 
arch  describe  in  outline  a  parabola  or  semi-ellipse  with  a 
slight  flattening  of  the  curve  in  the  region  of  the  incisor 
and  bicuspid  teeth,  and  a  consequent  tendency  to  angularity 
where  the  cuspids  are  placed.  The  lower  arch  differs  from 
the  upper  principally  in  being  slightly  smaller.  The  teeth 
when  thus  placed  should  be  in  contact,  each  one  touching 
its  neighbor  at  the  most  prominent  points  of  its  approximal 
surfaces,  and  with  the  cusps  or  occluding  surfaces  properly 
articulating  with  those  in  the  opposite  jaw.  When  thus 
arranged  the  teeth  are  called  regular. 

An  irregularity  may  be  defined  as  any  variation  from  the 
above  order.  It  may  consist  in  a  deviation  from  the  normal 
outline  on  the  part  of  several  or  all  of  the  teeth,  or  in  the 
malposition  of  one  or  more  individual  teeth ;  if  the  latter, 
the  tooth  or  teeth  may  be  found  outside  or  inside  of  the  reg- 
ular line  of  the  arch  or  they  may  be  placed  anteriorly  or 
posteriorly  to  their  normal  positions,  or  finally,  they  may 
be  turned  or  twisted  on  their  axes.  In  many  cases  this 
torsion  is  associated  with  malposition. 


PRINCIPLES    IxVVOLVED.  11 

An  irregularity  being  an  abnormality,  corrective  measures, 
as  a  rule,  should  be  resorted  to,  but  slight  irregularities  do 
not  always  demand  interference. 

The  slight  overlapping  of  the  superior  centrals  by  the  lat- 
erals, for  instance,  is  a  clear  case  of  irregularity,  but  it  is  so 
slight  and  so  commonly  met  with,  that  it  has  almost 
ceased  to  attract  attention  or  to  Ije  regarded  as  an  abnormal- 
ity. Artificial  teeth  are  now  made  reproducing  this  condition 
and  in  many  cases  are  preferred  on  account  of  their  "  more 
natural  appearance." 

So  too,  the  slight  irregularity  commonly  found  in  connec- 
tion with  the  inferior  incisors,  where  several  or  all  of  them 
are  slightly  turned  and  overlapping,  is  no  longer  looked 
upon  as  inharmonious  and  is  also  imitated  in  the  arrange- 
ment of  artificial  teeth . 

Again,  the  slight  misplacement  of  a  tooth  in  the  posterior 
part  of  the  arch,  where  it  is  not  noticeable,  may  be  left 
without  disturbance  and  no  harm  result. 

In  cases  like  these,-  if  the  slightly  altered  position  of  the 
individual  teeth  is  not  likely  to  result  in  injury  to  tooth 
structure,  or  does  not  interfere  with  speech  or  occlusion,  it 
is  best  to  omit  any  effort  toward  correction. 


CHAPTER  II. 

ETIOLOGY. 

The  causes  responsible  for  the  production  of  irregularity 
are  many  and  at  best  but  imperfectly  understood.  Some  of 
them  are  operative  before  the  birth  of  the  individual  and 
others  afterward.  They  may  therefore  be  classed  under  the 
two  general  heads  of  Hereditary  and  Acquired. 

HEREDITARY. 

This  class  comprises  all  such  cases  as  are  evidently  due  to 
the  inheritance  of  peculiarities  that  existed  in  their  near  or 
remote  ancestors,  or  to  some  of  the  characteristics  of  both 
parents  who  were  themselves  free  from  dental  abnormality. 

The  well-known  biological  law  of  transmission  of  charac- 
teristics from  parent  to  child  will  readily  explain  how  the 
abnormalities  as  well  as  the  normalities  may  be  transmitted. 
The  child  may  bear  a  close  resemblance  to  either  parent  in 
form  and  feature,  or  it  may  combine  some  of  the  peculiari- 
ties of  both.  In  other  cases  it  will  resemble  neither,  but 
be  like  one  of  the  grandparents  or  other  remote  relatives. 

The  evidences  of  inheritance  are  perhaps  nowhere  more 
clearly  expressed  than  in  the. dental  organs.  Not  only  in 
these  organs  as  a  whole  may  we  see  the  dental  apparatus  of 
a  progenitor  reproduced  in  entirety,  but  the  resemblance  is 
equally  well  shown  in  the  inheritance  of  so  slight  an  abnor- 
mality as  a  turned  or  misplaced  tooth.  Sometimes  such 
peculiarity  may  be  inherited  by  several  children  in  the  same 
family. 

Cases  of  irregularity  due  to  inheritance  are  oftentimes  the 
most  difficult  to  correct,  for  not  only  must  mechanical  diffi- 
culties be  overcome,  but  in  addition  the  influence  of  physi- 
cal impress,  confirmed  perhaps  by  repeated  transmission, 

12 


PRINCIPLES    INVOLVED.  13 

must  be  combatted.  The  mechanical  difficuUies  in  such 
cases  are  as  readily  conquered  as  in  otliers,  but  the  force  of 
inheritance  will  show  itself  in  a  strong  and  stubborn  ten- 
dency on  the  part  of  the  teeth  to  return  to  their  former 
abnormal  position. 

The  intermarriage  of  races  with  widely  differing  cliarac- 
teristics  has  come  to  be  regarded  as  one  of  the  most  prolific 
causes  of  dental  irregularity.  If  both  races  represented  in 
the  marriage  possess  somewhat  similar  characteristics  as  to 
size,  vigor  and  feature,  no  dental  peculiarity  will  usually  be 
found  in  the  offspring ;  but  where  the  differences  are 
marked,  irregularity  of  the  teeth  will  often  be  the  result. 

When  one  parent  possesses  a  large  frame  with  full-sized 
teeth  set  in  large  jaws  and  the  other  a  small  frame  with  cor- 
respondingly small  jaws  and  small  teeth,  the  child  may 
inherit  the  large  teeth  of  one  parent  and  the  small  jaws  of 
the  other.  The  small  jaws  cannot  accommodate  the  full 
complement  of  the  larger  teeth,  and  hence  a  crowded  and 
irregular  dental  arch  will  be  the  result. 

Where  the  small  teeth  of  one  parent  and  the  large  jaws 
of  the  other  are  found  united  in  the  offspring,  abnormal  in- 
terdental spaces  will  frequently  be  the  result.  These  spaces 
may  exist  between  all  of  the  teeth,  or,  as  in  some  cases,  the 
deformity  will  only  be  found  in  connection  with  the  anterior 
ones.  Cases  of  this  character,  fortunately,  are  infrequently 
met  with,  but  when  they  occur  they  present  an  unsightly 
appearance,  and  generally  result  in  an  earlier  loss  of  the 
teeth  from  that  lack  of  contact  and  mutual  support  so 
necessary  to  their  longest  retention  and  usefulness. 

ACQUIRED. 

The  causes  productive  of  irregularity  during  dentition  or 
subsequent  to  it  far  exceed  in  number  those  due  to  heredity. 

LONG    RETENTION    OP    DECIDUOUS    TEETH. 

In  accordance  with  physiological  law,  the  deciduous  teeth 
are  intended  to  subserve  the  wants  of  the  child  until  re- 
placed by  the  permanent  set.     The  crown  of  the  permanent 


14  ORTHODONTIA. 

tooth  should  occupy  a  position  beneath  or  adjacent  to  the 
root  of  the  deciduous  one  whicli  it  is  intended  to  supplant. 
Then,  as  the  root  of  the  temporary  tooth  is  gradually  re- 
moved, the  permanent  tooth  advances  and  finally  occupies 
the  position  previously  occupied  by  its  predecessor. 

It  frequently  happens,  however,  that  the  crypt  of  the  per- 
manent tooth  is  situated  at  some  little  distance  from  the 
root  of  its  corresponding  deciduous  one,  and  as  the  new 
tooth  makes  its  way  into  place  it  assumes  a  position  to  the 
side  of  the  deciduous  root.  As  usually  that  part  of  the  root 
is  absorbed  which  is  in  contact  with  the  vascular  covering 
of  the  advancing  crown,  a  portion  of  the  length  of  the  root 
remains  unabsorbed,  and  the  new  crown  is,  in  consequence, 
compelled  to  advance  by  the  side  of  the  root  instead  of 
beneath  it.  The  deciduous  tooth  as  a  result  of  its  only  par- 
tially absorbed  root,  remains  firm  in  place,  and  the  new 
one  is  erupted  out  of  its  proper  position.  Had  the  condition 
been  brought  to  the  knowledge  of  the  dentist  before  the  new 
crown  appeared,  the  extraction  of  the  deciduous  tooth  would 
have  permitted  the  advancing  tooth  to  assume  its  proper 
position  in  the  arch  and  irregularity  have  been  prevented. 
When  the  permanent  tooth  is  advancing  out  of  position  the 
fact  may  be  recognized  by  the  unusual  distension  of  the  gum 
and  alveolar  plate  beneath,  and  the  deciduous  tooth,  no  mat- 
ter how  firmly  set,  should  at  once  be  removed.  Even  the 
spicula  of  a  deciduous  root  has  been  found  sufficient  to  de- 
flect a  permanent  tooth  from  its  course  during  eruption. 

EARLY    EXTRACTION    OP    DECIDUOUS    TEETH. 

That  the  premature  extraction  of  deciduous  teeth  often 
prepares  the  way  for  irregularity  of  the  permanent  set  is 
generally  recognized,  but  the  extent  of  its  importance  and 
the  manner  in  which  it  operates  can  best  be  understood  by 
considering  the  physiological  facts  in  the  case. 

Irregularity  of  the  deciduous  teeth  is  a  condition  very 
seldom  met  with.     As  a  rule  they  occupy  their  normal  posi- 


PRINCIPLES    INVOLVED.  15 

tioiis  ill  an  alveolar  arch  of  [)roper  size  to  accommodate 
them,  and  this  again  rests  upon  a  jaw  bone  of  suitable 
amplitude.  Thus  jaw^  process  and  teeth  are  harmoniously 
correlated.  As  each  deciduous  tooth  is  lost  it  is  succeeded 
by  the  corresponding  permanent  one,  which,  under  normal 
conditions,  will  occupy  the  space  created  by  the  removal 
of  its  predecessor.  In  this  way,  one  by  one,  the  permanent 
set  should  make  its  appearance  until  all  of  the  deciduous 
teeth  have  been  supplanted  by  their  permanent  successors. 

The  permanent  teeth  are  all  larger  than  the  corresponding- 
ones  of  the  deciduous  set,  with  one  exception, — the  second 
bicuspid.  This  being  the  case,  they  require  a  larger  alveo- 
lar arch  and  a  correspondingly  larger  jaw  bone  for  their 
accommodation.  This  nature  furnishes  by  the  slow  pro- 
cess of  enlargement  by  interstitial  growth,  which  is  hastened 
and  stimulated  by  the  lateral  pressure  of  the  teeth  as  they 
make  their  way  into  place,  and  afterward.  When  the  first 
permanent  molar  makes  its  appearance  it  is  obliged  to 
provide  sufficient  accommodation  for  itself  by  forcing  its 
way  between  the  deciduous  second  molar  and  the  strong 
maxillary  tuberosity  above  or  the  equally  resistant  ramus 
below.  This  pressure  is  felt  by  all  the  other  teeth  in  the 
arch.  If,  therefore,  any  of  the  deciduous  molars  should  be 
extracted  about  the  fifth  or  sixth  year,  for  instance,  as  they 
too  often  are  after  having  been  impaired  by  disease,  the 
permanent  molar  will  move  forward  and  occupy  part  of 
the  space  intended  for  the  bicuspids. 

When  the  permanent  lower  central  incisors  erupt  they 
make  their  a]3pearance  inside  of  the  deciduous  ones,  which 
soon  loosen  and  drop  out.  Owing  to  the  fact  that  the 
width  of  these  new  teeth  is  considerably  greater  than 
that  of  their  predecessors,  they  naturally  overlap  to  a 
certain  extent  the  adjoining  deciduous  laterals.  This  over- 
lapping prevents  the  centrals  from  moving  forward  into 
line  in  the  arch.  When  the  permanent  laterals  erupt  they 
■assume  a  position  by  the  side  of  the  centrals,  and  to  find 


16  ORTHODONTIA, 

accommodation  in  this  contracted  space  inside  of  the  arch 
several  or  all  of  them  are  apt  to  be  crowded  into  irregular 
positions. 

This  condition,  from  the  fact  that  these  teeth  have  erupted 
too  rapidly  to  admit  of  a  corresponding  increase  in  size  of 
the  alveolar  arch,  is  often  regarded  as  a  serious  evil,  and  to 
correct  it,  the  inexperienced  practitioner  will  in  many 
cases  extract  the  temporary  cuspids  which  are  designed  for 
retention  until  years  afterward.  This  add,itional  space 
having  been  thus  furnished,  the  permanent  incisors  will 
move  forward  into  line  and  assume  a  regular  position. 

Later,  when  the  bicuspids  appear,  they  will  usually  find 
no  difficulty  in  assuming  places  in  the  arch,  because  their 
predecessors  occupied  a  larger  space  and  because  the  cuspids 
are  missing,  but  from  the  very  abundance  of  the  space  and 
the  pressure  of  the  first  molar  from  behind,  the  bicuspids 
will  very  soon,  if  not  at  once,  be  so  pressed  forward  that  the 
first  bicuspid  will  come  in  contact  with  the  lateral,  leaving 
no  space  for  the  accommodation  of  the  cuspid  when  it  makes 
its  appearance  at  about  the  eleventh  or  twelfth  year. 

Such  being  the  case,  the  cuspid  must  of  necessity  erupt 
outside  or  inside  of  the  arch,  and  produce  a  deformity  both 
unsightly  and  hard  to  correct. 

Had  the  temporary  cuspids  not  been  extracted,  they 
would  have  preserved  space  for  their  successors,  and  the 
inlocked  and  irregular  incisors,  in  the  course  of  time,  by 
the  normal  enlargement  of  the  arch,  and  the  excess  pro- 
vided by  the  removal  of  the  deciduous  molars,  would  have 
had  space  sufficient,  which  nature,  assisted  by  the  pressure  of 
the  tongue,  would  aid  them  in  occupying. 

The  same  condition  is  met  with  in  the  superior  arch,  per- 
haps more  frequently  than  in  the  inferior.  Here  the  incis- 
ors erupt  outside  of  the  deciduous  ones,  and  sometimes 
appear  in  an  irregular  and  crowded  position,  to  correct 
which  the  temporary  cuspids  are  often  needlessly  sacrificed, 
and  the  same  train  of  evils  follows. 


PRINCIPLES    INVOLVED.  17 

It  will  thus  be  seen  that  the  premature  extraction  of  any 
of  the  temporary  teeth,  especially  the  cuspids,  cannot  well 
result  in  other  than  harm  to  the  permanent  ones,  so  far  as 
regularity  is  concerned. 

Sir  John  Tomes  relates  a  case  in  which  he  extracted  for 
cause  all  of  the  deciduous  teeth  of  a  child,  and  yet  when 
the  permanent  ones  appeared  they  assumed  their  proper 
positions  in  the  arch  without  any  resultant  irregularity. 

This  one  case,  however,  the  only  one  of  the  kind  on 
record,  does  not  disprove  the  facts  as  noticed  in  thousands 
of  cases  of  opposite  character,  nor  does  it  confute  the  plainly 
apparent  workings  of  physiological  law.  It  simply  illus- 
trates what  nature  may  do  in  a  single  case  under  conditions 
exceptionally  "favorable. 

INJUDICIOUS    EXTRACTION    OF    PERMANENT    TEETH. 

A  condition  frequently  met  with  after  all  the  permanent 
•teeth  have  been  erupted,  is  one  where  in  the  upper  jaw  the 
centrals,  bicuspids  and  molars  are  all  harmoniously  ar- 
ranged, while  the  laterals  occupy  a  position  inside  of  the 
arch  and  the  cuspids  lie  outside  of  it.  The  condition  is 
most  frequently  brought  about  by  the  premature  extraction 
of  one  or  more  members  of  the  temporary  set,  as  described 
under  the  last  heading. 

To  remedy  the  difficulty  in  the  easiest  manner,  some 
practitioners  have  at  times  extracted  the  laterals  and  on 
other  occasions  the  cuspids.  The  result  has  been  in  each 
case  an  almost  hopeless  deformity.  The  cuspids  brought 
next  to  the  centrals  oftentimes  gives  to  the  face  a  canine 
appearance,  while  with  cuspids  lacking  the  countenance  is 
robbed  of  that  prominence  near  the  angles  of  the  mouth 
so  necessary  to  harmonious  expression. 

Again,  the  first  permanent  molars  of  one  of  the  jaws  are 
often  neglected  until  caries  has  made  serious  inroads  upon 
them,  when  they  are  extracted  as  offending  members.  The 
result  is  that  the  lateral  pressure,  so  necessar}^  to  proper 


18 


ORTHODONTIA. 


expansion  of  the  process  is  lacking  in  one  jaw,  while  in  the 
other  the  normal  enlargement  continues.  As  a  consequence 
there  is  disparity  as  to  size  between  the  two  jaws,  and  the 
appearance  of  the  individual  is  perhaps  permanently 
marred. 

DELAYED  ERUPTION  OF  PERMANENT  TEETH. 

It  sometimes  happens,  from  causes  not  easily  definable, 
that  the  eruption  of  one  or  more  of  the  permanent  teeth  is 
retarded  to  such  a  degree  that  the  rest  of  the  set  take  posi- 
tions in  the  arch  and  occupy  all  the  space.  When  the 
tardy  member  is  ready  to  erupt  there  is  no  place  for  it,  and 
it  is  compelled  to  take  a  position  outside  or  inside  of  the 
line.  This  is  apt  to  occur  more  frequently  with  the  cuspids 
than  any  of  the  other  teeth,  although  it  is  occasionally  met 
with  in  the  case  of  laterals  and  bicuspids. 


Fig.  1. 


SUPERNUMERARY    TEETH. 

Supernumerary  teeth  are  very  frequently  found  occupying 
a  position  in  the  arch  before  the  eruption  of  the  permanent 
set,  so  that  when  the  latter  appear  there  is  insufficient  room 
for  some  of  their  number,  and  these  are  forced  to  assume  an 
abnormal  position.      Such  supernumerary  teeth  as  appear 

in  the  line  of  the  arch  and 
in  the  anterior  part  of  the 
mouth  are  usually  small  and 
of  the  conical  or  peg-tooth  va- 
riety, and  are  most  frequently 
found    between    the   central 


incisors. 

Fig.  1  re})resents  a  case  of 

Torsion  caused  by  Supernumerary.  l\^{^    ]^ji-^(j    jj^  ^hc  mOUth  of  a 

Japanese  boy,  nine  years  of  age,  in  which  as  a  result  of  the 
presence  of  the  extra  tooth,  the  right  central  is  turned  one- 
fourth  of  a  circle,  while  its  mate  is  also  somewhat  rotated. 


PRINCIPLES    INVOLVED. 


19 


Fig.  2  illustrates  another  case  very  similar  in  character. 
In  this  instance  the  supernumerary  tooth  erupted  to  the 
Pj^  2  side   of  the  median 

line,  and  so  only  the 
one  incisor  was  de- 
flected from  its  nor- 
mal position. 

Sometimes  the  pres- 
ence of  a  supernum- 
erary  tooth    has   no 
lif/i  '^^^^^  effect  upcm  the 

/l\  M  permanent   set  than 

-^-^     to    occupy    part     of 

Torsion  caused  by  Supernumerary.  ^j^g  spaCe  ill  tllC  arch 

and  separate  the  adjoining  teeth  by  its  own  width.*  Even 
this,  however,  is  objectionaljle,  for  in  most  cases  the  tooth, 
being  abnormal  in  form,  will  have  to  be  extracted  and  an 
attempt  made  to  close  the  space  thus  created. 


ACCIDENTS. 

An  accidental  injury  to  one  or  more  of  the  teeth  of  either 
set,  whether  resulting  in  their  loss  or  not,  is  often  respon- 
sible for  an  irregular  condition.  Should  a  deciduous  tooth 
become  devitalized,  as  the  result  of  an  accident  or  other 
cause,  and  alveolar  abscess  supervene,  the  physiological  act 
of  absorption  will  be  suspended,  and  the  succeeding  tooth 
in  the  course  of  its  eruption  will  naturally  be  deflected  from 
its  course  and  erupt  in  an  abnormal  position. 

So,  also,  it  has  happened  that  a  deciduous  incisor,  through 
a  fall,  has  been  driven  up  into  the  process.  Such  a  mis- 
fortune can  harcuy  fail  to  cause  an  injury  to  the  partially 
formed  permanent  tooth  lying  beneath  it.     Should  no  more 


*  A  model  in  the  Museum  of  the  Philadelphia  Dental  College  represents 
two  supernumerary  teeth  occupying  the  space  between  the  central  incisors. 
None  of  the  teeth  are  turned  or  misplaced,  and  but  for  the  presence  of  these 
two  vagrants,  the  dental  arch  would  in  all  respects  be  a  typical  one. 


20  ORTHODONTIA. 

serious  result  follow,  it  will  probably  at  least  divert  the  new 
tooth  from  its  course  and  be  productive  of  irregularity. 

The  author  had  one  such  case  in  his  practice  with  an 
irregularly  placed  permanent  tooth  as  the  result. 

ADENOID    VEGETATIONS. 

Within  the  past  ten  years  the  attention  of  oral  and  aural 
surgeons  has  been  especially  directed  toward  the  ill  effects 
resulting  from  the  presence  of  adenoid  vegetations  in  the 
naso-pharynx. 

These  growths  are  often  found  in  children  as  early  as  the 
second  year  of  life,  and  by  partially  or  wholly  closing  the 
posterior  nares,  interfere  greatly  with  natural  breathing- 
through  the  nose.  The}^  also  frequently  cause  marked  im- 
pairment of  hearing  by  impinging  upon,  or  closing  the^ 
mouth  of  the  Eustachian  tube. 

It  has  been  noticed  that  their  presence  is  nearly  always 
associated  with,  and  by  inference  productive  of,  a  pinched 
appearance  in  the  superior  maxillary  and  nasal  regions  of 
the  face.  This  condition  is  believed  to  be  attributable  to 
lack  of  development  of  the  frontal,  sphenoidal  and  eth- 
moidal sinuses  and  the  antrum  of  Highmore,  which  being 
normally  in  contact  with  the  air,  cease  to  develop  when  the 
circulation  of  the  air  through  the  nose  is  interfered  with, 
resulting  in  altered  dimensions  of  the  face. 

This  lack  of  development  in  the  osseous  structures  con- 
tiguous to  the  oral  cavity  is  very  likely  to  produce  a  high 
and  contracted  vault  associated  with  a  V-shaped  arch,  and 
such  condition  of  the  vault  and  arch  has  usually  been  found 
in  cases  where  adenoid  growths,  through  lack  of  discovery, 
have  been  allowed  to  remain  through  a  number  of  years. 

That  these  growths  are  directly  or  indirectly  responsible 
for  the  malposition  of  teeth  (as  has  been  stated  by  some 
medical  writers)  other  than  the  angular  position  of  the 
superior  central  incisors  as  found  in  the  V-shaped  arch,  we 
have  no  reason  to  believe ;  but  inasmuch  as  any  alteration 


PRINCIPLES    INVOLVED.  21 

of  the  normal  form  of  the  arch  and  vault  is  in  itself  an 
abnormality,  manifesting  itself  in  the  facial  expression,  and 
perhaps  seriously  interfering  with  proper  and  needful  occlu- 
sion of  the  teeth,  it  is  very  important  that  where  the  pre- 
sence of  such  growths  is  suspected,  a  careful  examination  by 
means  of  the  finger  or  mirror  should  be  made,  and,  if  found, 
the  case  should  at  once  be  referred  to  a  specialist  for  surgi- 
cal treatment. 

HABITS. 

The  bad  habits  which  young  children  are  apt  to  acquire 
after  they  are  weaned,  such  as  thumb-,  lip-  or  tongue-suck- 
ing, are  important  factors  in  bringing  about  an  irregular 
alignment  of  the  teeth  in  one  or  more  portions  of  the  arch. 
Acquired  early,  while  the  temporary  teeth  are  in  position 
and  firmly  set,  the  habit  wall  usually  make  no  impression 
upon  them,  but  if  not  checked  and  allowed  to  continue  up 
to  the  time  of  the  coming  of  the  permanent  set,  as  is 
sometimes  the  case,  these  will  generally  be  thrown  out  of 
position  or  so  altered  in  their  relationship  as  to  cause  a 
serious  deformity. 

This  is  readily  accounted  for  when  we  consider  that  the 
erupting  teeth,  seeking  their  position  in  the  arch  and  sur- 
rounded by  newly  formed  and  pliable  alveolar  tissue,  are 
easily  turned  out  of  their  course  by  any  extraneous  force 
exerted  upon  them. 

The  general  results  of  the  triple  habit  are  the  same, 
although  they  vary  in  particulars.  In  thumb-sucking, 
usually  only  two  or  three  of  the  incisors  are  pressed  out  of 
place,  and  the  ones  affected  are  determined  by  the  hand 
used  and  the  position  of  the  thumb  in  the  mouth.  In  lip- 
and  tongue-sucking,  owing  to  the  larger  surface  of  the  organ 
employed,  all  of  the  incisors  will  be  affected. 

Not  only  has  the  point  of  introduction  of  the  thumb  to 
be  considered  in  relation  to  its  effects,  but  also  the  angle  at 
which  it  is  held.     When  the  position  of  the  thumb  in  rela- 


22 


ORTHODONTIA. 


tion  to  the  teeth  forms  less  than  a  right  angle,  the  upper 
teeth  will  be  thrown  out  and  the  lower  ones  in ;  but  when 
held  in  a  horizontal  position,  the  upper  and  lower  teeth  are 
not  displaced,  but  simply  held  apart.  As  a  result  of  this 
the  first  molars  are  kept  from  present  contact  and  naturally 
elongate  until  in  time  they  come  together.  The  mouth  is 
thus  permanently  propped  apart  in  front,  and  when  the 
second  molars  erupt  and  come  into  occlusion  the  ill-condi- 
tion is  confirmed.  With  these  eight  firm  teeth  in  contact, 
there  is  no  longer  any  hope  of  the  ten  anterior  ones  elon- 
gating sutficiently  to  meet,  and  we  have  the  deformity 
known  as  "lack  of  anterior  occlusion,"  which  is  not  only 
a  disfigurement,  but  a  serious  disadvantage  to  the  individual 
in  mastication  and  speech.  This  lack  of  anterior  occlusion 
is  not  always  due  to  the  habit  of  thumb-sucking,  for  it  may 
be  brought  about  by  physical  peculiarities,  as  noticed  fn 
Part  III.,  Chapter  X. 

In  lip-sucking  the  lower  lip  is  drawn  into  the  mouth 
over-  the  lower  teeth,  and  held  there  for  varying  periods 
both  day  and  night.  The  result  is  that  by  the  force  thus 
exerted  the  lower  teeth  are  thrown  in  and  the  upper  ones 
out  to  such  an  extent  as  to  give  them  unnatural  promi- 
nence, and  to  cause  spaces  to  exist  between  them. 

Fig.* 3  illustrates  this  condition.  The  child  when  brought 
to  the  author  for  consultation,  was  eleven  years  of  age,  and 
a  confirmed  victim  to  the  Fig.  3,  ■ 

habit  of  lip-sucking.  Near- 
ly all  of  the  permanent 
teeth  in  each  jaw  were 
erupted  and  harmoniously 
related,  except  the  ever- 
sion  and  introversion  of 
the  upper  and  lower  in- 
cisor teeth  respectively. 
The  teeth  were  brought  into  proper  position,  and  the  habit, 
by  thus  being  made  impossible,  was  broken  up. 


Eversion  and  Introversion. 


PRINCIPLES    INVOLVED.  23 

The  displacement  and  failure  of  occlusion  of  teetli  in 
the  anterior  part  of  the  moutli  are,  however,  not  the  only 
evils  associated  with  this  habit  in  its  three  forms.  In  eacli 
case  the  jaws  are  held  temporarily  apart  so  that  there  could 
be  no  occlusion  of  the  teeth  even  though  they  articulated 
normally  when  the  jaws  were  closed.  This  leaves  the  side 
teeth  free  to  change  their  position  if  any  influence  is  exerted 
to  produce  tliat  result.  In  the  act  of  sucking,  the  cheeks 
are  drawn  in  and  the  .strong  pressure  thus  brought  to  bear 
upon  the  bicuspids  and  (occasionally)  the  first  molars,  may 
cause  them  to  be  bent  inward.  In  this  mal-position  they 
are  frequently  confirmed  by  the  opportunity  thus  given  the 
other  molar  teeth  to  move  forward,  of  which  they  are  not 
slow  to  take  advantage. 

IRREGULARITIES    OR   DEFORMITIES   WITH    MIXED   ETIOLOGICAL 
CHARACTERISTICS. 

There  are  some  typical  malformations  of  the  teeth  and 
jaws  the  causes  of  .which  cannot  be  classed  under  either  the 
hereditary  or  the  acquired  form,  but  combine  certain  feat- 
ures of  both. 

Among  the  more  prominent  of  these  are  protrusion  of 
the  upper  jaw,  prognathism,  and  the  "  V "  and  saddle 
arches. 

SUPERIOR    PROTRUSION. 

In  this  condition  the  superior  teeth  project  forward  and 
outward  to  such  an  extent  as  to  leave  a  space,  more  or  less 
great,  between  their  cutting  edges  and  those  of  the  lower, 
thus  producing  a  marked  deformity  and  giving  to  the  indi- 
vidual a  slightly  imbecile  expression.  The  lower  anterior 
teeth,  when  the  jaws  are  closed,  may  rest  in  contact  with 
the  bases  of  the  superior  ones,  or  they  may  impinge  upon 
the  gum  tissue  adjacent. 

In  some  cases  this  deformity  is  but  the  expression  of  a 
.  tendency   inherited    from   a   progenitor   under   conditions 


24  ORTHODONTIA. 

favorable  to  reproduction,  while  in  others  it  may  be,  and 
doubtless  is,  the  result  of  mechanical  forces  finding  mani- 
festation in  the  individual  alone.  Even  if  inherited  it 
must  have  been  the  result  of  such  causes  in  the  individual 
with  whom  it  originated.  In  its  acquired  form,  this  abnor- 
mality may  be  caused  by  the  slow  eruption  of  the  posterior 
teeth,  which  by  failing  to  come  in  contact  for  a  long  time 
permit  of  an  unusually  long  over-bite  in  the  incisor  region. 
The  lower  incisors  thus  articulating  with  the  upper  ones 
near  their  bases  have  a  tendency  to  force  the  latter  forward 
and  outward,  these  movements  being  favored  by  the  thin 
plate  of  alveolar  process  overlying  the  outer  surfaces  of 
their  roots.  As  the  upper  teeth  move  outward  the  lower 
ones,  from  lack  of  restraint,  elongate  until  their  cutting 
edges  occupy  a  plane  considerably  above  that  of  their 
fellows,  oftentimes  fitting  into  and  irritating  the  soft  tissues 
in  the  roof  of  the  mouth. 

The'  same  result  is  sometimes  similarly  brought  about 
later  in  life,  when  through  loss  of  several  of  the  side  or 
back  teeth  the  burden  of  mastication  is  thrown  upon  the 
front  ones.  Lack  of  occlusion  posteriorly  and  excessive 
pressure  anteriorly  will  thus  produce  a  deformity  that  did 
not  exist  early  in  life. 

In  some  cases  it  may  also  be  caused  by  the  mal-eruption 
of  certain  of  the  posterior  teeth,  permitting  them  to  assume 
a  position  in  advance  of  or  posterior  to  their  normal  place : 
such  a  condition  would  tend  to  restrain  the  lower  teeth  from 
pressing  forward,  and  cause  the  upper  ones  to  advance 
unnaturally. 

The  abnormality  appears  exaggerated  in  cases  where 
from  some  cause  the  lower  incisors  incline  inward,  thus 
causing  the  upper  ones  to  seem  more  protruded  than  they 
really  are. 

PROGNATHISM. 

This  deformity,  consisting  in  the  abnormal  protrusion  of 
the  inferior  teeth  and  jaw,  is  one  very  frequently  met  with. 


PRINCIPLES   INVOLVED. 


25 


Fig.  4. 


It  gives  to  the  individual  somewhat  of  a  canine  expression, 
and  for  this  reason  is  very  aptly  designated  by  the  Germans 
as  "  Hundemaul."  In  some  cases  the  lower  anterior 
teeth  occlude  with  the  superior  ones,  but  pass  outside  of 
them,  while  in  others  the  lower  jaw  and  teeth  are  protruded 
to  such  an  extent  as  to  make  the  articulation  of  the  lower 
anterior  and  side  teeth  with  those  of  the  upper  jaw  a  physi- 
cal impossibility. 
Fig.  4  represents  an 
extreme  case  of  this 
character.  The  de- 
formity is  not  only 
very  unsightly,  but 
inter  feres  seriously 
with  mastication.  It 
is  no  doubt  due  in 
many  cases  to  arrest 

of  development  of  the  Excessive  Protrusion. 

superior  arch,  and  is  favored  by  any  cause  or  causes  that 
tend  to  lessen  the  extent  of  contact  in  occlusion.  That  the 
lower  jaw  possesses  an  inherent  tendency  to  move  forward 
when  occlusion  does  not  prevent  is  abundantly  shown  in 
cases  where  the  individual  has  become  edentulous  and  no 
artificial  teeth  are  worn.  Even  the  occlusion  of  artificial 
teeth  will  lessen  or  check  this  tendency. 

In  many  cases  it  is  an  undoubted  inheritance,  while  in 
others  it  may  be  brought  about  by  local  conditions.  It  is 
liable  to  occur  in  all  cases  where  it  is  not  prevented  by 
mechanical  influences. 


V-ARCH. 

The  angular  or  V-shaped  arch  is  not  an  uncommon  one. 
In  a  typical  arch  of  this  character,  the  teeth  instead  of  form- 
ing an  arch,  are  arranged  in  two  straight  but  convergent 
lines,  which  meet  at  an  angle  where  the  central  incisors 
join  each  other.     The  molars,  bicuspids  and  cuspids  are 


26 


ORTHODONTIA. 


Fig.  5. 


usually  properly  related  to  one  another,  but  simply  thrown 
inward,  forming  straight  lines  instead  of  curves.  The  in- 
cisors, however,  by  this  contraction  of  the  space  are  not  only 
thrown  forward,  but  turned  upon  their  axes  so  that  their 
lingual  surfaces  present 
toward  each  other.  Fig. 
5  *  represents  this  form  of 
irregularity.  It  is  in  all 
cases  confined  to  the  supe- 
rior maxilla,  the  lower  one 
being  harmonious  in  out- 
line. The  pressing  forward 
of  the  incisor  teeth  and 
their  torsion  often  gives 
such  prominence  to  the  lip 
that  the  teeth  remain  ex- 
posed even  when  the  jaws 
are  closed.     In  addition  to  v-Arch. 

this  unsightliness,  the  speech  is  often  seriously  affected  by 
the  free  and  uncontrollable  escape  of  air  when  articulation 
is  attempted. 

The  causes  responsible  for  this  condition  are  probably 
shrouded  in  greater  obscurity  than  those  of  any  other  form 
of  irregularity. 

The  crowding  of  teeth  during  eruption,  delayed  eruption 
or  mal-occlusion,  some  of  which  are  evidently  responsible 
for  many,  forms  of  irregularity,  cannot  be  called  to  account 
for  this  condition,  for  none  of  them  could  press  the  teeth  into 
such  symmetrically  straight  lines.  Mr.  Charles  Tomes  be- 
lieves that  it  is  brought  about  by  the  pressure  of  the  muscles 
of  the  cheeks  upon  the  sides  of  the  arch  while  sleeping  with 
the  mouth  open,  and  that  this  habit  is  due  to  enlargement 
of  the  tonsils,  which  prevents  full  breathing  through  the 
nose. 


■  From  a  model  in  the  collection  of  Dr.  W.  F.  Fandenberg. 


PRINCIPLES    INVOLVED.  27 

The  pressure  of  the  cheeks  covering  so  large  a  surface 
would  be  just  the  kind  of  force  likely  to  produce  this  sym- 
metrical contraction  of  the  arch,  but  we  are  confronted  Avith 
the  fact  that  in  mouth-breathing  the  jaws  are  never  held 
far  apart,  and  also  that  the  masseter  and  buccinator  mus- 
cles, owing  to  their  points  of  insertion,  stand  clear  of  the 
teeth,  so  that  even  when  somewhat  flexed,  they  could  not 
possibly  produce  pressure  upon  these  organs. 

The  condition  is  nearly  always  associated  with  a  high  and 
narrow  vault,  and  it  may  be  possible  that  both  of  these  fea- 
tures have  been  brought  about  by  imperfect  development  of 
adjacent  parts,  especially  of  the  vomer,  which  stands  in  the 
relation  of  a  pillar  or  support  to  the  palate. 

SADDLE-ARCH. 

This  deformity,  though  less  common  than  the  preceding- 
one,  and  giving  less  external  evidence  of  its  existence,  is  far 
more  likely  to  favor  decay  on  account  of  increased  surface 
contact.  In  seeking  an  explanation  for  its  existence,  it  is 
well  to  remember  that  the  bicuspid  teeth  (the  ones  most 
usually  affected)  are  situated  immediately  beneath  the  de- 
ciduous molars,  and  succeed  to  their  positions.  As  the  first 
set  occupies  an  arch  in  every  way  smaller  than  the  perma- 
nent one,  the  position  of  the  bicuspids  would  locate  them 
inside  of  the  arch  described  by  the  permanent  teeth  alread}^ 
in  place.  When  there  is  no  obstacle  to  prevent,  they  natu- 
rally move  outward  into  place ;  but  where  insufficient  space 
does  not  permit  this,  they  are  obliged  to  remain  where  they 
are,  or  in  an  effort  to  force  their  way  into  line,  assume  a 
crowded  and  irregular  position. 

The  fact  that  when  bicuspids  are  out  of  line  they  are 
nearly  always  found  to  be  inside  of  the  arch  seems  to 
favor  the  supposition  that  the  irregularity  has  been  brought 
about  in  the  manner  suggested.  Early  eruption  of  the  cus- 
pids and  tardy  eruption  of  the  bicuspids  would  also  favor 
the  condition. 


28 


ORTHODONTIA. 


The  assumption  that  bicuspids  once  in  hne  may  be 
forced  out  of  it  by  pressure  exerted  in  tlie  eruption  of  the 
second  and  third  molars  has  httle  to  support  it.  Were  this 
possible  or  probable  the  deformity  would  be  more  frequently 
met  with.  Fig.  6  is  a 
fair  representation  of 
this  deformity.  Both 
sides  of  the  arch  are 
not  usually  affected 
to  the  same  extent, 
and  in  some  cases  the 
two  bicusi3ids  on  one 
side  occupy  a  posi- 
tion directly  across 
the  arch,  each  one 
being  partly  turned 
upon  its  axis.  The 
condition  is  rarely 
met  with  in  the  lower  Fig.  6. — Saddle-Arch  (Coleman). 

jaw,  and  is  one,  according  to  the  author's  observation,  never 
inherited,  but  always  acquired. 


CHAPTER  III. 

EVILS    ASSOCIATED    WITH    IRREGULARITY. 

In  order  to  properly  appreciate  the  importance  of  cor- 
rection of  irregularit}^  of  the  teeth,  it  will  be  well  to  con- 
sider in  brief  detail  some  of  the  more  prominent  evils  asso- 
ciated with  the  condition. 

APPEARANCE    MARRED. 

While  this  result  is  usually  not  the  most  important  of 
those  connected  with  irregularity,  it  is  the  one  which  most 
generally  induces  the  patient  to  apply  for  remedial  treat- 
ment. The  other  evils  may  not  be  recognized,  or  may  be 
considered  of  minor  importance  by  the  parent,  but  the  ill- 
appearance  of  the  child  both  attracts  the  attention  and 
enlists  the  sympathy  to  such  an  extent  as  to  create  a  desire 
for  its  improvement. 

The  external  deformity  caused  by  an  irregularity  will  be 
greater  or  less  according  to  its  extent  and  location.  If  it  be 
slight  in  character  and  located  back  of  the  cuspid  teeth,  it 
will  usually  give  no  external  evidence  of  its  existence,  but 
if  located  in  the  anterior  part  of  the  mouth,  it  will,  even  if 
slight,  be  very  noticeable  and  in  consequence  constitute  a 
source  of  annoyance  to  the  individual  throughout  life. 

The  class  of  irregularities  most  noticeable  under  all  con- 
ditions is  that  where  the  form  of  the  arch  is  altered,  thus 
changing  in  a  marked  degree  the  entire  facial  expression. 
Such  deformity  cannot  be  masked.  It  must  either  be 
mechanically  reduced  or  stoically  endured. 

SPEECH    AFFECTED. 

This  result  like  the  preceding  one  will  be  slight  or  aggra- 
vated according  to  circumstances,  but  when  at  all  consider- 

29 


30  ORTHODONTIA. 

able  it  proclaims  itself  to  the  world  with  every  attempt  at 
speech  in  so  unpleasant  a  manner  as  to  be  a  painful  annoy- 
ance to  both  speaker  and  listener. 

It  may  be  due  to  the  restriction  of  the  movements  of  the 
tongue  as  in  a  narrow  or  contracted  arch,  to  alteration  of 
the  form  of  the  roof  or  vault  of  the  mouth  where  the  sides 
of  the  latter  have  assumed  a  deep  pitch  resulting  in  the 
formation  of  a  sharp  angle  along  the  median  line  of  the 
palate,  or,  it  may  be,  and  most  usually  is,  due  to  the  uncon- 
trollable escape  of  air  between  the  teeth  in  the  anterior  part 
of  the  mouth  by  virtue  of  the  non-approximation  of  those 
teeth  and  the  change  of  form  in  that  part  of  the  alveolar 
ridge  which  aids  the  tongue  in  the  production  of  perfect 
sounds. 

MASTICATION  IMPAIRED. 

In  most  cases  of  irregularity,  either  simple  or  complicated, 
there  is  a  corresponding  degree  of  either  mal-occlusion  or 
lack  of  occlusion.  In  simple  cases,  or  where  but  few  teeth 
are  thrown  out  of  occlusion,  it  may  not  occasion  any  incon- 
venience to  the  individual,  but  where  the  irregularity  is  at 
all  extensive  so  many  teeth  are  usually  lacking  in  occlusion 
as  to  seriously  impair  the  power  of  mastication. 

When  this  latter  condition  prevails  it  is  most  likely  to 
result,  sooner  or  later,  in  injury  to  other  organs,  for  where 
mastication  is  imperfectly  performed  greater  demand  is 
made  upon  the  stomach  to  prepare  the  food  for  digestion 
and  assimilation.  The  stomach  soon  feels  the  effect  of  this 
over-taxation  and  becomes  weakened  in  tone,  which  may 
finally  result  in  incapacitating  it  for  the  performance  of  its 
normal  functions. 

Teeth  that  do  not  occlude  are  of  no  use  to  the  individual 
for  purposes  of  mastication,  and  those  that  occlude  but 
slightly  or  imperfectly  possess  very  slight  value. 

As  one  of  the  principal  functions  of  the  teeth  is  mastica- 
tion, and  as  all  the  teeth  are  needed  to  perform  this  work 


PRINCIPLES    INVOLVED.  31 

satisfactorily,  it  naturally  follows  that  any  interference  with 
this  function,  through  irregular  position  or  otherwise,  must 
be  detrimental  to  the  individual  and  may  result  in  partial 
or  complete  loss  of  health. 

CARIES    INDUCED. 

The  human  teeth  are  arranged  in  the  jaws  in  such  man- 
ner as  to  best  subserve  the  wants  of  the  individual,  and 
their  form  and  location  are  also  such  as  to  conduce  to  the 
greatest  immunity  from  caries  and  their  consequent  longest 
endurance. 

Their  rounded  approximal  surfaces  and  the  constriction 
of  their  necks  reduces  the  points  of  contact  with  their  fellows 
to  the  minimum.  As  their  liability  to  apjDroximal  decay  is 
in  proportion  to  the  amount  of  surface  in  contact,  it  will  be 
seen  that  those  normally  placed  are  likely  to  be  freest  from 
the  ravages  of  caries. 

When,  therefore,  the  teeth  occupy  irregular  positions, 
especially  where  they  are  crowded,  more  of  the  surface  of 
each  tooth  is  in  contact,  and  the  liability  to  decay  is  corres- 
pondingly increased.  This  is  true  of  irregularly  placed 
teeth  in  any  part  of  the  arch,  but  the  liability  is  greatly 
increased  where  crowding  or  overlapping  exists  among 
the  incisor  teeth,  for  owing  to  their  flattened  form  it  is  possi- 
ble for  more  of  their  surface  to  be  in  contact  with  their 
fellows  than  would  be  possible  with  any  of  the  other  teeth. 
In  such  cases,  with  the  condition  uncorrected,  teeth  decay 
and  re-decay,  in  spite  of  the  most  faithful  efforts  of  the  den- 
tist, until  they  are  finally  lost. 


CHAPTER  lA^ 

ADVISABILITY    OF    CORRECTION. 

With  our  present  knowledge  in  regard  to  the  teeth  and 
their  surrounding  tissues,  and  the  advancement  made  of 
recent  years  in  the  multiphcation  and  perfection  of  mechan- 
ical appliances,  scarcely  any  deformity  of  the  mouth  and 
teeth  is  beyond  mechanical  remedy.  With  possibility 
assured,  however,  it  is  most  important  that  we  should  con- 
sider carefully  the  question  of  advisability,  for  what  is  pos- 
sible may  not  always  be  advisable.  There  are  several  con- 
siderations that  enter  into  this  question  of  advisability. 

AGE. 

The  age  of  the  patient  has  much  to  do  with  the  advisa- 
bility of  any  proposed  operation  for  correction.  Early  in 
life,  when  the  alveolar  tissues  have  not  yet  reached  the  hard- 
ness and  density  of  structure  which  they  will  attain  at  a 
later  period,  they  are  more  easil}^  operated  upon.  They  are 
elastic  and  readily  yield  to  pressure,  and  at  the  same  time 
under  the  influence  of  this  pressure  they  are  more  quickly 
resorbed  or  bent  and  thus  give  way  to  the  tooth  that  is 
being  moved.  This  feature  of  early  youth  is  an  important 
and  valuable  one  in  that  it  renders  an  operation  for  correc- 
tion more  easy  of  accomplishment,  but  while  the  soft  and 
easily  yielding  ];)rocess  favors  the  operation,  it  is  at  the  same 
time  a  tissue  poorly  fitted  to  resist  the  influences  which  often 
operate  to  again  displace  the  tooth.  For  this  reason,  a  tooth 
moved  at  an  early  age  may  be  liable  to  subsequent  displace- 
ment when  the  pressure  caused  by  the  eruption  of  the  suc- 
ceeding teeth  is  brought  to  bear  upon  it. 

After  maturity,  we  have  the  conditions  exactly  reversed. 
The  denser  and  more  perfectly  calcified  process  yields  less 

32 


PRINCIPLES    INVOLVED.  33 

readily  to  pressure  and  absorption,  but  when  the  tooth  has 
once  been  moved  into  proper  position  it  is  more  easily  and 
firmly  held  there  by  tlie  surrounding  tissues. 

In  view  of  these  facts  it  will  readily  be  seen  that  in  many 
cases,  especially  where  the  proposed  operation  is  simple  in 
character,  and  where  the  result  obtained  is  not  likely  to  be 
nullified  by  subsequent  events,  interference  early  in  life  is 
advisable,  but  where  the  operation  is  to  be  extensive  in 
character,  and  especially  where  we  have  reason  to  doubt  our 
ability  to  retain  the  results  secured,  prudence  would  suggest 
non-interference  until  all  of  the  fourteen  teeth  of  the  involved 
jaw  have  erupted. 

HEALTH. 

The  health  and  strength  of  the  patient  at  the  time  of  any 
proposed  operation  for  irregularity  is  so  important  a  consid- 
eration that  it  dare  not  be  disregarded.  The  time  that  is 
generally  considered  most  favorably  for  correction  (between 
the  ages  of  thirteen  and  eighteen  years)  is  also  a  period 
when  important  changes  are  going  on  in  the  entire  economy. 
The  individual  is  passing  from  the  stage  of  childhood  into 
that  of  manhood  or  womanhood,  and  in  this  change, 
especially  in  the  case  of  the  female,  the  life-forces  are  taxed 
to  the  utmost.  At  this  time  also  the  mental  faculties  are 
being  severely  strained  by  study,  in  consequence  of  which,  if 
the  physical  culture  of  the  individual  be  neglected,  as  it  too 
often  is,  the  nervous  system  becomes  unduly  exalted. 

To  meet  and  partially  compensate  for  these  drains  upon 
the  system,  it  is  most  important  that  full  nutrition  be  sus- 
tained. To  do  this  with  teeth  that  are  sore  or  tender  to  the 
touch  from  being  moved  is  impossible,  and  hence  the  system 
will  be  still  further  weakened  by  lack  of  nourishment  if  any 
severe  operation  be  undertaken. 

At  this  period  of  life,  therefore,  unless  the  patient  possesses 
vital  powers  of  a  high  order,  it  might  be  unwise  to  further 
tax  his  or  her  system  by  any  extensive  operation  for  cor- 


34  ORTHODONTIA. 

rection  that  would  involve  the  infliction  of  much  pain, 
discomfort  or  annoyance.  Should  the  vitality  of  the  patient 
be  below  the  average,  no  difficult  or  protracted  operation  for 
correction  should  be  undertaken,  for  it  might  result  in  per- 
manent impairment  of  the  health. 

It  is  much  better  to  postpone  the  oj^eration  until  a  time 
when  the  vital  powers  can  stand  the  strain  or  if  necessary 
abandon  it  altogether,  for  the  loss  of  health  can  never  be 
compensated  for  by  any  benefit  conferred  upon  the  dental 
organs. 

SEX. 

The  sex  of  the  individual  must  also  be  considered  in  con- 
nection with  this  subject.  The  consideration  of  sex  may  be 
disregarded  so  far  as  the  desirability  of  an  operation  is  con- 
cerned— for  if  the  results  of  neglected  irregularity  are  harm- 
ful in  respect  to  one  sex,  they  are  certainly  equally  so  in 
regard  to  the  other — but  as  regards  the  necessity  for  inter- 
ference the  question  of  sex  is  an  important  one.  Correct 
facial  expression  and  harmony  of  feature  are  far  more  im- 
portant to  the  female  than  to  the  male ;  for,  being  endowed 
by  nature  with  greater  beauty  of  form  and  feature  than  man, 
its  absence  in  any  part  is  more  noticeable  than  it  would  be 
in  the  sterner  sex.  Besides  this,  after  youth  is  passed,  man 
has  in  the  hairy  covering  of  the  lip  a  means  of  concealing 
most  deformities  of  the  dental  arch,  while  woman  is  entirely 
without  this  advantage.  For  these  reasons  the  necessity  for 
the  correction  of  any  irregularity  of  the  teeth  seems  more 
imperative  in  woman  than  in  man. 

POWER    OP    APPRECIATION. 

The  intelligence  of  the  patient  and  his  ability  to  properly 
appreciate  any  benefit  conferred,  are  important  considera- 
tions in  enabling  us  to  determine  whether  or  not  to  under- 
take any  considerable  operation  for  the  correction  of  irregu- 
larity. 


PRINCIPLES    INVOLVED.  35 

Correction  of  irregularity  is  at  best  a  most  difficult  under- 
taking, and  frequently  lacking  in  suitable  pecuniary  reward, 
so  that  the  lover  of  the  art  must  nearly  always  depend  upon 
appreciation  for  part  of  his  compensation.  If  this  be 
wanting,  the  operation  is  robbed  of  nearly  or  quite  all  of 
its  attractiveness,  and  the  stimulus  to  success  is  absent. 

There  are  those  whose  want  of  intelligence  or  lack  of  cul- 
ture would  lead  them  to  regard  with  much  indifference  any 
irregularity  of  their  teeth,  and  who  if  benefited  by  our 
efforts  for  correction  would  fail  to  appreciate  it.  For  such  it 
would  be  manifestly  unwise  to  urge  or  encourage  any  diffir 
cult  or  extensive  operation  for  correction  even  though  they 
might  be  able  to  compensate  us  pecuniarily  for  our  labor, 
for  they  would  be  likely  either  to  give  up  the  operation  when 
partially  completed  or  fail  to  wear  any  appliance  for  reten- 
tion, and  thus  permit  failure  to  follow  success. 

FAMILY    TYPE. 

When  any  great  deformity  of  the  teeth  and  jaws,  such  as 
anterior  protrusion  of  either  jaw  or  a  A'^-shaped  arch  is  shown 
to  be  hereditary,  it  is  well  to  take  into  consideration  the 
hereditary  feature  of  the  case  before  beginning  any  opera- 
tion for  correction.  Where  the  irregularity  is  known  to  have 
been  acquired  in  the  parent  of  the  child  and  thus  to  have 
been  transmitted  but  once,  the  difficulties  in  the  case  are  not 
so  marked  because  the  type  has  scarcely  been  confirmed ;  but 
where  it  has  been  transmitted  through  two  or  more  genera- 
tions the  impress  is  strong  and  difficult  to  overcome. 

In  the  latter  case  the  correction  of  the  deformity  will  not 
be  more  difficult  than  usual,  but  after  correction  the  ten- 
dency of  perverted  nature  to  cause  a  return  to  the  family 
type  will  be  so  strong  as  to  almost  baffie  us  in  our  attempts 
to  preserve  the  advantage  we  have  gained.  Under  such  cir- 
cumstances the  retaining  appliance  will  have  to  be  worn  a 
very  long  time,  and  a  constant  watch  kept  over  the  case 
until  we  are  sure  that  the  result  will  be  permanent. 


36  ORTHODONTIA. 


IMPROVEMENT    OF    OCCLUSION. 


Faulty  occlusion  is  always  necessarily  associated  with 
irregularity  and  is  one  of  its  most  objectionable  features. 
While  mastication  may  be  performed  to  the  satisfaction  of 
the  individual  where  an  irregularity  exists,  it  can  neither 
approach  the  ideal  of  nature  nor  properly  subserve  its  own 
ends  , unless  the  teeth  articulate  in  a  normal  manner.  It 
would  be  difficult  to  find  a  set  of  teeth  in  which  the  articu- 
lation is  all  that  could  be  desired,  but  the  nearest  ap- 
proach to  it  is  what  we  should  strive  after.  Therefore,  in 
considering  the  advisability  of  correction  in  any  given  case, 
we  should  carefully  study  the  existing  conditions  and  en- 
deavor to  ascertain  in  advance  whether,  when  we  have  im- 
proved the  arrangement  of  the  teeth,  we  have  also  improved 
the  articulation. 

Dr.  Davenport  says  :  *  "  In  the  treatment  of  our  patients, 
it  is  hoped  that  if  we  cannot  all  see  our  way  clearly  upon 
this  matter,  we  may  at  least  see  far  enough  not  to  make  the 
articulations  worse  by  our  operations  than  they  were  when 
brought  to  us." 

"  Much  harm  is  done  by  the  use  of  regulating  appliances 
which  change  the  articulation  without  improving  it,  and  it 
is  almost  a  universal  fact  that  unless  an  improvement  can 
be  made  in  the  articulation,  there  will  be  no  permanent 
improvement  in  the  irregularity." 

*  International  Deutal  Journal,  Jan.,  '92. 


CHAPTER  V. 

AGE  AT  WHICH  CORRECTION  MAY  BE  BEGUN. 

The  correction  of  irregularities,  under  favoring  condi- 
tions, may  be  begun  and  carried  forward  successfully 
through  a  wide  range  of  3'ears. 

It  may  be  undertaken  as  early  as  the  eighth  or  ninth  year, 
and  again  may  yield  successful  results  as  late  as  the  thirty- 
fifth  year  or  later.  The  operation  is  one  largely  dependent 
upon  the  absorption  and  re-formation  of  alveolar  tissue,  and 
as  new  bone  will  form  at  almost  any  period  of  life,  as  evi- 
denced by  the  reunion  of  a  fracture,  so  the  correction  of  an 
irregularity  is  possible  at  quite  a  late  period. 

The  correction  of  irregularity,  however,  would  usually 
prove  so  slow  and  tedious  an  operation  after  the  maximum 
of  density  had  been  attained  in  the  process,  and  the  neces- 
sity for  it  be  so  much  lessened  by  advancing  age,  that 
the  advisability  of  undertaking  it  would  be  questionable. 

WHEN    EARLY    INTERFERENCE    IS    JUSTIFIABLE    AND 
ADVISABLE. 

Any  of  the  j)ermanent  teeth  may  erupt  outside  or  inside 
of  the  arch.  If  allowed  to  remain  in  such  position  for  any 
length  of  time,  the  space  intended  for  their  accommodation 
will  soon  be  partly  occuj)ied  by  the  adjoining  teeth,  and 
the  subsequent  correction  of  the  irregularity  rendered  more 
difficult.  So  also  a  central  or  lateral  incisor  often  erupts  in 
such  a  manner  that  its  cutting  edge,  instead  of  being  in  line 
with  the  curve  of  the  arch,  forms  an  angle  with  it. 

37 


38 


ORTHODONTIA. 


Torsion  and  Overlapping. 


Fig.  8. 


Torsion  with  Space. 


This  torsion  may  be  associated  with  an  overlapping  of  the 
adjacent  tooth  as  shown  in  Fig.  7,  or  there  may  be  a  space 
between  the  two  as  shown  in  Fig.  8.  fig.  7. 

In  either  case  the  twisted  tooth 
occupies  a  less  space  at  the  line  of  the 
cutting  edge  than  it  should.  By  al- 
lowing this  condition  to  remain,when 
the  pressure  of  the  later  erupting 
teeth  begins  to  be  felt,  these  teeth 
will  be  pressed  still  closer  together 
and  the  irregularity  be  confirmed. 
Subsequently,  when  tlae  correction 
of  the  condition  is  attempted,  there 
will  not  be  sujSicient  room  to  accommodate  the  tooth  in  its 
wider  aspect  and  the  adjoining  teeth  will  have  to  be  pressed 
apart  or  the  arch  expanded  to  obtain  the  necessary  room ; 
whereas,  if  the  tooth  had  been  turned  in  its  socket  before 
the  eruption  of  the  other  teeth  the  operation  would  have 
been  a  very  simple  one. 

Again,  when  an  incisor  erupts  so  as  to  occupy  a  position 
inside  of  the  arch  in  the  upper  jaw,  or  outside  of  it  in  the 
Fig.  9.  lower,  and  the  tooth  be 

held  in  such  position  by 
the  antagonizing  teeth, 
immediate  interference 
and  correction  is  de- 
manded in  order  to  pre- 
vent the  complications 
that  would  result  from 
the  partial  or  complete 
closure  of  the  space  in- 
tended for  the  accom- 
modation  of  the    mal- 

Inlocked  Laterals.  pOSed      tOOth.  Fig.      9 

shows  a  case  of  this  character  with  both  laterals  inlocked. 
The  superior  central  incisors  sometimes  erupt  in  such  a 
manner  that  their  cutting  edges  form  an  angle  at  the  median 


PRINCIPLES    INVOLVED. 


39 


Torsion  of  both  CentruK. 


lino.  To  neglect  the  condition  or  to  postpone  its  correction 
would  not  only  result  in  its  confirmation  and  probable  aggra- 
vation, but  might  also  open  the  way  for  a  complete  change 
in  the  shape  of  the  arch.     Fig.  10  illustrates  this  condition. 

It  is  entirely  probable  that  certain  arches  of  a  modified 
V-sliape  have  been  formed  in  this  Fi«-  lo. 

way.     In  cases  such  as  those  just 
mentioned,   early    interference   is 

the  wiser  plan,  but  it  is  equally g^^^\^  ^^^.^^^ 
important  that  after  they  have  f|  \  ^^^^^^^^^p  \  \ 
been  placed  properly  in  line  tho\' 
should  be  firmly  held,  not  only 
until  new  bony  tissue  has  been  formed  around  them,  but 
until  the  lateral  pressure  of  the  neighboring  teeth  coming 
into  place  has  spent  itself. 

How  this  may  be  readily  and  successfully  done  is  shown 
in  the  consideration  of  j)ractical  cases  in  Part  III. 

In  the  lower  jaw  the  conditions  are  somewhat  different. 
The  incisors,  upon  eruption,  generally  assume  a  somewhat 
crowded  and  irregular  position,  which  is  partly  or  entirely 
corrected  by  nature  in  the  enlargement  of  the  arch  and  the 
influence  of  the  lip  and  tongue  in  bringing  them  into  a 
more  harmonious  outline. 

Interference  with  them  when  they  are  within  the  arch  is 
not  usually  called  for  until  a  later  period. 

While  there  are  many  practitioners  who  have  long  held 
the  view  that  early  interference  is  inadvisable  in  the  great 
majority  of  cases,  the  large  experience  of  others  who  have 
made  a  specialty  of  this  branch  of  practice  has  led  them  to 
declare  in  favor  of  early  correction.* 


*  "As  soon  after  eruption  as  it  becomes  certain  that  an  irregular  denture 
is  inevitable,  there  is  no  longer  justification  for  delay,  and  after  that  period 
every  year  increases  the  difficulties,  both  mechanical  and  pathological,  and 
prejudices  the  stability  of  the  dental  apparatus.  .  .  .  The  author  has 
not  hesitated  to  undertake  treatment  of  very  extensive  irregularities,  even 
while  teeth  were  emerging  from  the  gums." — Kingsley — Oral  Deformities, 
pp.  61,  62. 


40  ,      ORTHODONTIA. 

Certainly  where  the  case  is  brought  to  our  attention  in 
its  incipiency  we  can  frequently  by  judicious  management 
and  the  application  of  slight  corrective  measures  either 
counteract  or  greatly  modify  any  tendency  toward  irregu- 
larity. 

A  feature  favoring  early  correction  is  that  the  roots  of  the 
teeth  are  not  fully  calcified  until  a  long  time  after  their 
eruption.  Until  fully  calcified  the  apical  foramina  are 
large  and  more  than  accommodate  the  nutrient  vessels 
entering  the  tooth,  so  that  there  is  less  danger  of  devitaliz- 
ing the  pulp  through  strangulation  in  the  movement  of  a 
tooth  at  this  period  than  later. 

WHEN  CORRECTION  SHOULD  BE  DELAYED  UNTIL  DENTITION 

IS  COMPLETE. 

In  some  cases  an  extensive  operation  for  the  correction  of 
irregularity  involving  a  number  of  teeth,  should  not  be 
undertaken  until  all  of  the  permanent  teeth  (excepting  the 

"  It  is  the  opinion  of  the  writer  that  each  tooth  should  be  encouraged  to 
take  a  correct  position  in  the  circle  of  the  arch  while  erupting  (or  as  soon 
thereafter  as  practicable),  in  order  to  promote  the  proper  development  of  the 
jaw,  for  the  teeth  next  to  be  erupted  are  thus  more  likely  to  do  so  in  proper 
position  and  order." — Jackson — Trans.  Amer.  Dent.  Assoc,  1890,  p.  201. 

' '  I  believe  the  best  time  to  begin  the  treatment  is  as  soon  as  the  appear- 
ances of  irregularity  are  manifest,  then,  with  delicate  and  simple  appliances, 
gradually  assist  the  tooth  to  take  its  natural  position.  ...  A  few  days 
with  a  proper  appliance  will  often  accomplish  what  may  require  many 
months  if  left  until  the  whole  dental  apparatus  is  involved." — Angle — Pam- 
phlet, p.  50. 

"Early  interference  is  often  necessary,  as  where  the  superior  incisors 
erupt  slightly  posterior  to  their  natural  ijosition  and  occlude  with  the  cut- 
ting edges  of  the  lower  ones.  Should  the  superior  incisors  not  be  moved 
forward  as  soon  as  this  tendency  is  noticed  permanent  prognathism  might 
result. ' '— Goddard— MSS. 

"  As  soon  as  a  tooth  (or  a  number  of  teeth)  erupting  show  such  misplace- 
ment that  natural  conditions  will  not  make  it  self-correcting,  mechanical 
means  should  at  once  be  resorted  to — no  matter  what  the  age.  The  only 
condition  that  would  not  justify  such  interference  is  ill-health." — Mat- 
teson— MSS. 


PRINCIPLES    INVOLVED,  41 

third  molars)  are  fully  erupted.  When  but  a  few  teeth  are 
malposed  with  no  prospect  of  their  being  able  to  take  their 
places  in  the  arch  unaided,  and  every  prospect  of  their  be- 
ing confirmed  in  their  malposition,  the  necessity  for  imme- 
diate interference  is  plainly  evident;  but  where  a  large 
number  of  teeth  are  malposed  it  is  not  so  easy  to  prognosti- 
cate what  effect  their  correction  may  have  when  considered 
in  relation  to  the  teeth  still  to  be  erupted.  The  result  is 
naturally  involved  in  some  doubt.  Even  if  the  necessity 
for  correction  appears  evident  to  us  and  we  should  accom- 
plish it,  the  final  result  may  not  be  all  that  we  had  hojoed 
for. 

Under  such  circumstances  it  is  wise  to  delay  interference 
until  the  permanent  teeth  are  in  place  and  the  arch  fully 
expanded,  when  by  a  careful  examination  of  all  the  condi- 
tions we  can  easily  foresee  the  result  of  any  proposed  opera- 
tion and  decide  intelligently  not  only  what  needs  to  be  done, 
but  also  the  best  way  of  accomplishing  the  desired  result. 
Oftentimes  this  later  examination  will  show  that  the  irregu- 
larity has  much  improved  and  the  necessity  for  interference 
is  consequently  lessened. 

The  line  of  distinction  between  the  advisability  of  early 
and  late  interference  is  not  always  plainly  marked,  but 
where  there  is  no  very  evident  reason  for  delay  prompt 
interference  is  the  safer  and  better  plan. 


CHAPTER  VI. 

MOVEMENTS    TO     BE    PRODUCED    AND    PRINCIPLES    GOVERNING 
THE    APPLICATION    OF    FORCE. 

In  causing  malposed  teeth  to  assume  their  proper  positions 
in  the  arch  certain  movements  are  necessary,  and  to  properly 
accomplish  them  force  must  be  brought  to  bear  in  a  manner 
best  calculated  to  produce  the  desired  result.  The  usual 
movements  that  teeth  undergo  in  being  forced  into  position, 
are  outward,  inward,  forward,  backward  and  rotary.  Some- 
times but  one  movement  is  necessary  in  the  case  of  a  single 
tooth,  but  more  frequently  several  are  required  before  proper 
alignment  is  secured. 

The  application  and  regulation  of  force  in  producing 
movements  of  the  teeth  are  governed  largely  by  the  general 
principles  of  applied  mechanics. 

The  greatest  good  can  he  obtained  from  any  force  only  when  it  is 
exerted  in  a  direct  line  with  the  movement  desired. 

To  this  end,  in  the  selection  or  application  of  any  devices 
for  the  moving  of  teeth,  preference  should  be  given,  caeteris 
paribus,  to  those  that  are  most  direct  in  their  action. 

The  application  of  direct  force,  however,  is  not  always 
possible  owing  to  the  position  the  power-producing  instru- 
ment would  have  to  occupy  in  the  mouth,  and  the  consequent 
interference  (as  in  the  lower  jaw)  it  would  cause  in  limiting 
the  movements  of  the  surrounding  or  adjacent  organs.  For 
this  reason  we  very  frequently  have  to  consent  to  the  use  of 
some  form  of  appliance  that  will  yield  power  in  a  line  that 
is  not  direct,  but  still  effective. 

42 


PRINCIPLES    INVOLVED.  43 

The  force  used  must  be  sufficient,  but  not  excessive,  and  not  too 
abruptly  applied. 

If  the  force  be  insufficient  to  accomplish  the  desired  object 
the  result  will  not  only  be  a  failure,  but  it  will  also  involve 
a  serious  waste  of  the  time  of  both  patient  and  operator ; 
whereas,  if  it  be  more  than  sufficient  it  might  cause  a 
fracture  of  one  of  the  alveolar  plates,  a  rupture  of  a  blood- 
vessel at  the  apical  foramen,  or  a  constriction  of  the  entire 
pulp  at  the  same  point,  resulting  in  its  devitalization. 

So,  also,  in  the  widening  of  the  arch,  if  the  force  be  too 
great  or  too  suddenly  applied  it  is  liable  to  result  in  the  sepa- 
ration of  the  superior  maxillar}'-  bones  at  the  palatal  suture. 
While  this  result  need  not  necessarily  be  harmful,  if  occur- 
ring to  a  limited  degree  only,  it  is  one  that  usually  occurs 
without  our  wish,  and  in  all  cases  requires  suspension  of 
further  operations  until  the  parts  have  again  united.  The 
greatest  prudence  and  care  are  necessary  in  the  application 
of  force  to  the  teeth. 

The  points  of  resistance  and  delivery  of  the  force  must  he  fixed 

points. 

The  j)oint  of  resistance,  or  in  other  words  the  point  selected 
to  resist  the  strain  of  an  appliance  while  it  is  being  exerted 
to  cause  movement  at  some  other  point,  must  necessarily  be 
fixed  and  immovable,  for  if  it  be  not  so,  fully  one  half  or 
more  of  the  force  expended  will  be  lost.  Besides  if  the 
anchor  tooth  or  teeth  should  yield  at  all  to  the  pressure 
they  would  be  pressed  out  of  place  and  thus  one  irregularity 
would  be  created  in  our  attempt  to  correct  another. 

No  factor  in  orthodontia  is  more  important  than  this. 

So,  also,  the  point  of  delivery  must  be  a  fixed  point.  By 
a  fixed  point  in  this  sense,  is  meant  one  that  will  receive  the 
force  in  such  way  that  none  of  it  will  be  lost.  As  the 
tooth  is  moved,  the  point  on  its  surface  where  the  force  is 
delivered  will  necessarily  move  with  it,  but  it  should  be  so 


44  ORTHODONTIA. 

arranged  that  in  this  movement  the  point  of  delivery  be  not 
changed.  A  change  at  this  point  will  be  as  disastrous,  and 
frequently  more  so,  than  at  the  point  of  resistance,  for  if 
the  appliance  should  slip  or  change  its  position,  the  force 
would  be  exerted  in  a  line  different  from  that  intended  and 
harm  result. 

Great  difficulty  was  formerly  experienced  in  making 
attachments  for  appliances  so  that  they  might  be  immovably 
held  where  placed,  but  since  the  introduction  of  the  metal 
band  or  ferrule  by  Dr.  Magill,  difficulty  of  this  character  has 
been  overcome. 

The  resistance  at  the  point  from  which  ive  exert  pressure  must  be 
greater  than  the  resistance  to  be  overcome  by  the  pressure. 

The  truth  and  importance  of  this  statement  would  seem 
to  be  self-evident. 

Our  points  of  resistance  usually  consist  of  one  or  more 
teeth  situated  at  some  distance  from  the  one  intended  to  be 
moved.  Occasionally,  a  single  tooth,  if  it  be  multi-rooted 
or  one  with  a  long  root  firmly  implanted,  will  be  sufficient 
for  our  anchorage,  provided  the  tooth  to  be  moved  be  single- 
rooted  and  of  not  too  great  resisting  power  ;  but  a  tooth  with 
a  single  root  wall  seldom  be  sufficient  for  anchorage  in  mov- 
ing any  other  tooth.  A  single  molar,  firmly  implanted, 
may  sometimes  be  sufficient  to  offer  resistance  in  the  moving 
of  a  bicuspid  or  incisor,  but  it  is  always  better,  if  possible, 
to  have  the  resistance  divided  among  several  teeth. 

A  cuspid  should  never  be  depended  upon  to  resist  alone 
the  force  needed  to  move  another  cuspid,  for  it  is  as  likely 
that  the  one  will  be  moved  out  of  as  the  other  into  place. 
The  force  of  resistance  should  always  be  as  much  distributed 
as  possible,  for  the  sake  of  safety. 

It  should  always  be  seen  to,  in  advance,  that  there  is  sufficient  space 
to  accommodate  the  tooth  in  the  new  position  it  is  to  occupy. 

The  importance  of  this  precautionary  measure  will  be 
readily  seen.     Unless  there  be  room  to  accommodate  a  tooth 


PRINCIPLES    INVOLVED.  45 

we  will  either  fail  in  our  efforts  to  move  it  or  succeed  only 
by  the  expenditure  of  an  amount  of  force  out  of  all  propor- 
tion to  the  requirements  of  the  case.  Instead  of  moving  one 
tooth  we  may  under  such  circumstances  have  to  move 
several  at  the  same  time,  a  difficult  and  oftentimes  unneces- 
sary undertaking. 

If  sufficient  room  does  not  exist  naturally,  we  can  increase 
it  by  separating  the  adjoining  teeth.  If  the  space  already 
existing  be  too  great  to  admit  of  the  use  of  rubber  wedges, 
the  object  can  be  accomplished  by  the  use  of  compressed 
wood,  or  other  suitable  substance. 

In  certain  favorable  cases  an  inlocked  tooth  may  be 
brought  into  place  and  room  provided  for  it  at  the  same  time 
by  the  use  of  the  combination  band  and  screw  (or  spring) 
appliance  shown  in  Part  3,  Chapter  III. 

In  many  cases  where  a  tooth  is  locked  out  of  place  the 
jaw  needs  or  will  bear  expansion  as  well.  In  such  cases,  of 
course,  we  expand  the  arch  first,  and  this  will  afford  us  room- 
to  bring  the  tooth  into  position. 

An  exception  to  this  rule  is  sometimes  found  in  the  case 
of  a  lower  incisor  placed  slightly  within  the  arch  and  held 
there  by  the  adjoining  teeth.  As  these  teeth  are  usually 
easily  moved  it  will  not  be  necessary  to  provide  room  in 
advance,  for,  if  our  point  of  resistance  be  sufficient,  we  can, 
by  the  use  of  a  jack-screw,  readily  force  the  tooth  into  line, 
notwithstanding  the  overlapping  of  adjoining  teeth.  An 
illustration  of  this  method  is  shown  in  Part  2,  Chapter  1. 

Where  expansion  of  the  superior  arch  seems  to  be  indicated 

satisfy  yourself  that  it  is  the  best  course  to  pursue  before 

undertaking  it. 

The  advisability  of  expanding  the  superior  arch  must  be 
determined  by  existing  conditions.  If  the  lower  arch  be 
larger  and  more  prominent  than  the  upper  one,  prevention 
of  further  enlargement  of  the  lower  one  by  extraction  of  one 
of  the  molars  on  each  side  may  be  better  practice  than 


46  *  ORTHODOISITIA. 

enlargement  of  the  superior  arch.  A  careful  consideration 
of  the  facial  expression  as  shown  in  the  harmony  of  its 
various  parts  will  help  us  to  decide  the  matter. 

Again,  the  size  of  the  superior  maxilla  should  also  be  a 
determining  factor.  To  spread  the  superior  teeth  upon  a 
bony  arch  of  moderate  or  inferior  size  in  order  to  make  them 
meet  or  overlap  the  prominent  teeth  in  the  lower  jaw  would 
cause  them  to  slant  outward  to  such  an  extent  as  to  produce 
in  itself  a  very  decided  deformity. 

The  relation  of  the  maxillary  as  well  as  the  dental  arches 
should  be  carefully  studied  before  any  plan  of  treatment  is 
decided  upon. 

Pressure  may  be  either  continuous  or  intermittent. 

The  question  of  the  use  of  either  continuous  or  intermit- 
tent pressure  in  the  regulation  of  teeth  did  not  arise  until 
Dr.  Farrar  declared,  a  number  of  years  ago,  that,  according 
to  physiological  law,  direct  and  intermittent  pressure  was  the 
only  kind  suitable  to  be  applied  in  the  moving  of  teeth. 

The  only  way  in  which  direct  and  intermittent  force  can 
be  applied  is  by  the  use  of  the  screw  in  one  of  its  various 
forms.  Continuous  pressure  is  that  which  we  obtain  from 
the  elasticity  of  the  metals,  from  rubber  either  partially  or 
fully  vulcanized,  and  from  the  expansion  of  wood,  sea-tangle 
or  other  like  substances.  The  action  of  these  substances 
cannot  well  be  interrupted  to  provide  a  period  of  rest,  but 
they  continue  their  action  until  the  force  they  are  designed 
to  exert  has  been  spent. 

The  screw  is,  in  most  cases,  one  of  the  best  methods  by 
w^hich  to  exert  pressure,  but  it  cannot  be  applied  to  advan- 
tage in  all  cases.  To  limit  ourselves  therefore  to  its  use, 
would  be  to  deny  ourselves  the  advantage  to  be  gained  by 
the  employment  of  the  various  substances  previously  enu- 
merated. 

So  far  as  the  author  is  aware  no  one  has  advocated  the 
exclusive  employment  of  continuous  pressure,  but  those  who 


PRINCIPLES    INVOLVED.  47 

believe  in  and  make  use  of  it,  also  avail  themselves  of  inter- 
mittent pressure  in  the  form  of  the  screw,  not  because  of  its 
interruptability,  but  because  of  its  directness  and  power. 

Experience  has  shown  that  by  continuous  pressure  equally 
good  results  have  been  produced  as  by  interrupted  pres- 
sure and  with  as  little  harm.  Those  who,  like  the  author, 
have  used  both  kinds  according  to  the  seeming  require- 
ments of  the  case  in  hand,  have  been  unable  to  notice  any 
advantage  in  the  one  over  the  other  as  viewed  from  a 
physiological  standpoint. 

Dr.  Atkinson  once  expressed  his  belief  that  continuous 
pressure  in  regulating  most  fully  stimulates  the  action  of  the 
osteoclasts  in  the  absorption  of  alveolar  tissue. 

Pressure  should  be  exerted  as  nearly  as  possible  in  a  line  at  right 
angles  to  the  long  axis  of  the  tooth. 

By  the  application  of  power  in  this  way  the  best  results 
are  accomplished.  If  the  power  be  applied  at  a  slight  angle 
from  above,  no  harm  will  result,  as  it  will  only  serve  to  keep 
the  tooth  in  its  socket  while  it  is  being  moved,  but  if  applied 
at  an  angle  from  below,  the  tendency  will  be  to  lift  the  tooth 
from  its  socket  and  serious  complications  may  ensue. 

This  last  result  is  most  liable  to  follow  the  use  of  a  jack- 
screw  applied  at  an  improper  angle,  when  by  its  direct  and 
excessive  power  the  tooth  may  be  elevated  and  partially 
dislodged. 

Pressure  once  applied  should  never  be  ivholly  relinquished  until 
the  operation  is  completed. 

When  from  any  cause  it  is  desired  to  suspend  the  move- 
ment in  progress,  it  may  be  done  by  temporarily  ceasing  to 
exert  pressure,  but  the  appliance  should  be  kept  in  position 
to  retain  the  advantage  gained.  If  removed,  the  teeth  would 
fall  back  toward  their  old  positions  and  great  soreness  and 
inconvenience  result. 


CHAPTER  VII. 

EXTRACTION    AS    RELATED    TO    ORTHODONTIA. 

Probably  no  feature  in  the  practice  of  Orthodontia  is  more 
important,  or  has  associated  with  it  greater  possibilities  for 
good  or  evil  to  the  patient  than  that  of  extraction. 

As  related  to  the  prevention  or  correction  of  irregularity, 
extraction  on  the  one  hand  may  be  of  the  greatest  possible 
benefit  or  on  the  other  it  may  result  in  irreparable  injury. 

Judicious  extraction,  if  undertaken  in  time,  will  often 
forestall  or  prevent  an  irregular  condition  of  the  teeth,  and 
in  other  cases  it  will  assist  greatly  in  simplifjdng  the  opera- 
tion of  correction.  Occasionally,  it  is  all  that  is  called  for 
on  our  part,  nature  performing  the  rest  of  the  operation 
unaided. 

Injudicious  or  ill-advised  extraction,  however,  may  com- 
plicate and  render  most  difficult  the  correction  of  cases 
which  in  themselves  were  not  difficult,  or  it  may  even  be 
the  immediate  cause  of  a  deformity  which  would  not  other- 
wise have  existed. 

The  paramount  importance,  therefore,  of  knowing  when 
to  extract,  and  when  not,  will  be  readily  recognized. 

To  properly  convey  to  the  student  a  fair  understanding 
of  these  circumstances,  in  as  concise  and  comprehensive  a 
manner  as  possible,  it  has  been  thought  best  to  formulate 
the  following  rules: 

Avoid,  if  possible,  extracting  any  of  the  six  anterior  teeth  in  the 

superior  arch. 

We  would  urge  this,  because  it  is  nearly  always  unneces- 
sary to  extract  them,  and  because  their  absence,  owing  to 
their  prominent  position,  would  be  more  noticeable  than 
that  of  other  teeth  in  the  mouth.     If  the  anterior  teeth 

48 


PRINCIPLES    INVOLVED.  49 

be  sound  and  only  irregular  in  position,  the  extraction  of  a 
bicuspid  from  one  or  both  sides  will  usually  give  us  suffi- 
cient room  for  spreading  the  anterior  teeth  and  moving 
them  into  their  proper  positions. 

It  has  happened,  however,  to  the  author  and  others,  to 
meet  with  cases  where  the  superior  laterals  were  locked 
inside  the  arch  by  the  close  approximation  of  centrals  and 
cuspids,  and  where  the  laterals  were^withal  so  badly  injured 
by  decay  and  disease  as  to  render  their  usefulness  doubtful 
if  brought  into  line.  In  such  few  cases  it  was  deemed  best 
to  extract  the  laterals,  especially  as  their  absence  would  not 
be  more  noticeable  afterward  than  before,  and  because  there 
was  good  occlusion  between  the  rest  of  the  teeth  in  the 
mouth. 

The  author  had  two  unusual  cases  present  to  him  in  one 
year  for  the  reduction  of  protrusion  of  the  anterior  superior 
teeth.  In  each  case  there  was  a  broken  or  badly  diseased  right 
central  incisor  that  was  beyond  hope  of  preservation.  In  these 
cases  it  did  not  happen  particularly  amiss,  for  the  extraction 
of  the  roots  afforded  room  for  drawing  in  the  remaining  five 
teeth,  thus  easily  reducing  the  deformity  and  at  the  same 
time  closing  the  space.  The  appearance  of  the  patient  in 
each  instance  was  greatly  improved,  and  the  absence  of  even 
so  large  a  tooth  as  the  central  was  scarcely  noticeable. 

It  must  be  borne  in  mind  that  in  the  cases  just  mentioned 
advantage  was  simply  taken  of  an  existing  condition  to 
simplify  an  operation.  Had  the  teeth  been  good,  the  proper 
plan  to  pursue  would  have  been  to  extract  a  bicuspid  on 
each  side  and  retract  the  anterior  teeth. 

In  another  case,  a  girl  eleven  years  of  age  had  lost  a  right 
superior  central  incisor  through  a  fall  from  a  swing.  Two 
days  after  the  accident,  and  when  the  tooth  had  been  mislaid 
or  thrown  away,  she  was  brought  for  treatment.  Only  two 
methods  of  remedying  the  difficulty  suggested  themselves. 
One  was  the  wearing  of  an  artificial  tooth  ;  the  other,  draw- 
ing the  teeth  together  to  close  the  space.     The  latter  plan 


50  ORTHODONTIA. 

was  decided  upon,  and  successfully  carried  into  effect ;  but, 
unfortunately,  as  there  had  been  no  protrusion  before  and 
there  was  contraction  afterward,  the  superior  teeth  no  longer 
overlapped  the  lower  ones,  but  met  them  edge  to  edge,  thus 
giving  the  upper  jaw  a  flattened  appearance,  which  was  in 
itself  a  deformity.  The  patient  was  saved  the  annoyance  of 
wearing  a  plate,  but  her  facial  expression  was  injured  in 
consequence. 

Such  cases  as  those  just  alluded  to  are  exceedingly  rare, 
and  are  only  mentioned  as  extraordinary  exceptions  to  a 
very  good  rule.  Aside  from  the  centrals,  there  is  probably 
less  excuse  for  the  extraction  of  the  cuspids,  than  any  of  the 
anterior  teeth,  and  yet  it  is,  unfortunately,  too  often  resorted 
to. 

If  for  any  cause  the  cuspids  erupt  abnormally,  and  there 
is  no  room  for  them  in  the  arch,  if  it  be  not  advisable  to 
expand  the  arch,  one  of  the  teeth  on  each  side  should  be 
extracted  to  make  room  for  them. 

The  question  of  which  tooth  to  extract  (where  extraction 
is  deemed  best)  in  order  to  allow  an  outstanding  cuspid  to 
be  brought  into  line  will  be  largely  governed  by  the  position 
that  this  tooth  occupies.  If  it  be  situated  in  a  line  between 
the  lateral  and  first  bicuspids  with  its  root  sloping  backward, 
the  bicuspid  would  be  the  proper  tooth  to  extract.  If,  how- 
ever, the  slant  of  the  root  be  forward  the  lateral  incisor 
should  be  removed,  because  in  drawing  the  crown  of  the 
cuspid  forward  to  occupy  the  place  of  the  lateral,  it  would 
be  made  to  occupy  a  more  nearly  vertical  and  normal  posi- 
tion. To  move  the  crown  of  a  cuspid  forward  when  it 
already  inclines  forward,  or  backward  when  it  points  that 
way,  would  cause  it  to  present  such  an  oblique  appearance 
as  to  be  very  unsightly. 

In  the  lower  jaiv  one  of  the  incisors  may  sometimes  be  extracted 

to  gain  space. 

Slight  irregularity  or  crowding  of  the  inferior  incisors  is 
of  such  common  occurrence  as  to  have  almost  become  the 


'     I'KINCIl'LES    INVOLVED.  51 

rule  instead  of  the  exception.  Their  partial  concealment, 
together  with  the  usual  freedom  of  the  condition  from  ill 
results,  causes  any  interference  to  seem  meddlesome  rather 
than  otherwise,  if  the  irregularity  he  trifling.  In  cases, 
however,  where  the  crowding  is  excessive  and  calls  for  cor- 
rection, it  is  usually  the  easier  and  better  plan  to  extract  one 
of  the  implicated  teeth  and  bring  the  others  together  into 
line.  The  four  teeth  are  so  nearly  alike  in  size  and  charac- 
ter, that  the  loss  is  not  usually  noticed  when  one  has  been 
removed.  It  is  sometimes  perplexing  to  decide  which  of  the 
four  to  extract,  but  the  one  most  out  of  line,  and  in  conse- 
quence the  one  that  will  create  the  least  space  by  its  removal, 
should  usually  be  selected. 

In  respect  to  the  loss  of  the  inferior  cuspid,  the  same 
remarks  apply  as  to  its  fellow  in  the  opposite  jaw. 

Back  of  the  anterior  teeth,  if  all  are  equally  good  and  one  must 

he  removed,  select  the  one  nearest  and  posterior  to  the 

one  out  of  position. 

As  so  large  a  proportion  of  the  irregularities  we  are  called 
upon  to  correct  pertain  to  the  interior  teeth,  and  as  it  is  so 
important  to  retain  these,  extraction  for  room,  when  neces- 
sary, generally  falls  upon  one  of  the  teeth  posterior  to  the 
cuspids.  Which  of  these  it  is  best  to  extract,  to  make  room 
for  a  malposed  cuspid  or  incisor,  has  been  a  subject  of  con- 
troversy among  practitioners  for  many  years. 

Some  have  claimed  that  as  the  statistical  tables  show  the 
first  molar  to  be  by  far  the  least  durable  of  all  the  permanant 
teeth,  it  should  generally  be  selected  as  the  one  to  be  sacri- 
ficed. Others,  on  the  contrary,  have  contended  that  as  the 
first  and  second  bicuspids  are  both  frail  teeth,  and  are  often 
lost  early  in  life,  and  as  from  its  greater  size  the  first  molar 
is  so  much  more  valuable  in  mastication,  it  should  be  pre- 
served and  one  of  the  bicuspids  removed. 

There  is  truth  in  both  of  these  arguments,  but  we  feel 


52  ORTHODONTIA. 

satisfied  that  under  the  conditions  named,  (all  equally  good 
at  the  time,)  wisdom  will  dictate  the  removal  of  the  one 
nearest  the  point  of  difficulty,  for  in  so  doing  we  greatly 
simplify  the  operation  for  correction  and  effect  a  saving  all 
around.  Simplicity  in  surgical  as  well  as  mechanical  mat- 
ters is  a  great  desideratum.  Indeed,  it  not  infrequently 
happens  that  where  a  cuspid  is  out  of  line  the  first  bicuspid 
has  usurped  its  place  in  the  arch,  so  that  if  we  were  to 
extract  the  first  molar,  both  first  and  second  bicuspids 
would  have  to  be  moved  out  of  their  position  of  good  occlu- 
sion into  a  space  further  back,  a  feat  very  difficult  and  often- 
times well-nigh  impossible  of  accomplishment.  By  the 
simple  extraction  of  the  first  bicuspid  in  such  cases,  the 
cuspid  will  usually  fall  into  its  place  without  any  assistance. 
In  certain  cases  where  there  is  nearly  but  not  quite  suffi- 
cient space  in  the  arch  to  accommodate  an  outstanding 
cuspid,  and  where  the  occlusion  would  not  contra-indicate 
such  action,  it  is  better  to  extract  the  second  bicuspid  instead 
of  the  first,  because  the  surplus  space  thus  created  will  then 
be  back  of  the  first  bicuspid,  and  consequently  less  noticeable 
than  it  would  be  in  front. 

If  a  tooth  other  than  the  one  nearest  to"  that  in  malposition  be 

defective,  and  not  too  far  distant  from  point  of  irregularity, 

extract  it  instead. 

The  second  molar,  decayed  or  sound,  is  usually  too  far  dis- 
tant to  be  available  by  its  extraction  in  furnishing  room  for 
the  movement  of  anterior  teeth.  If  the  bicuspids  be  sound 
and  the  occlusion  does  not  interfere  with  their  backward 
movement,  the  first  molar,  if  very  defective,  may  be  extracted 
in  preference  to  a  sound  tooth  in  advance  of  it. 

So,  too,  if  the  second  bicuspid  be  carious  or  defective  and 
the  first  one  healthy,  the  former  should  for  the  same  reason 
be  extracted. 


PRINCIPLES    INVOLVED.  o3 

If  a  tooth  must  he,  lost,  either  to  allow  a  more  important  one  to 

fall  into  line  or  to  create  space,  it  should  be  done  without 

delay  to  accomplish  the  best  results. 

When  a  cuspid  erupts  without  room  in  the  arch  for  its 
accommodation,  and  the  circumstances  of  the  case  point  to 
the  extraction  of  the  first  bicuspid  to  make  place  for  it,  the 
sooner  the  extraction  takes  place  the  Ijetter.  If  the  opera- 
tion be  delayed,  the  cuspid  in  its  endeavor  to  force  its  way 
into  place  will  often  press  so  hard  upon  the  lateral  as  to 
force  it  inward,  and  if  possible  under  the  central,  thus 
creating  an  additional  irregularity.  8uch  results  have  often 
been  noticed.  Prompt  extraction  after  it  had  become  neces- 
sary would  have  changed  the  condition. 

In  similar  manner,  when  it  becomes  advisable  to  extract 
one  or  more  of  the  first  molars  to  prevent  the  further  expan- 
sion of  the  jaw  or  to  abort  a  threatened  irregularity  in  the 
anterior  part  of  the  arch,  it  is  best  not  to  delay  their  extrac- 
tion too  long.  They  should  not  be  extracted  before  the 
second  bicuspids  are  in  place,  but  if  they  must  be  lost,  they 
should  be  removed  after  the  eruption  of  the  latter  teeth  and 
before  the  second  molars  appear,  somewhere  about  the 
eleventh  or  twelfth  year.  If  longer  delayed  the  harm  we 
wished  to  prevent  (expansion  of  the  jaw)  will  have  been 
accomplished  and  their  later  extraction  will  not  avail.  If 
extracted  about  the  time  the  second  molars  are  erupting,  the 
latter  will  glide  naturally  into  the  space  formerly  occupied 
by  the  extracted  teeth ;  this  they  are  not  so  apt  to  do  later. 

If  a  tooth  must  be  removed  on  one  side  to  obtain  space  it  does  not 

necessarily  follow  that  its  mate  on  the  opposite  side  should 

also  be  extracted. 

If  there  be  the  same  reason  for  extracting  both,  as  where 
the  existing  evil  pertains  as  much  to  one  side  as  to  the  other, 
let  both  be  extracted ;  but  where  the  trouble  sought  to  be 
remedied  is  confined  to  one  side,  the  extraction  of  a  tooth  on 
that  side  ought  not  to  be  supplemented  by  a  useless  extrac- 


54     .  ORTHODONTIA. 

tion  on  the  other.  Those  who  favor  symmetrical  or  double 
extraction  claim  that  it  prevents  the  disturbance  of  the 
median  line,  but  it  has  been  our  experience  that  the  extrac- 
tion of  a  tooth  back  of  the  cuspid  will  not  often  affect  the 
central  line  through  the  moving  of  the  teeth  toward  the 
space,  and  even  a  slight  disturbance  of  that  line  is  far  less 
objectionable  than  the  sacrifice  of  a  valuable  tooth.  A  cor- 
respondent mentions  a  case  in  which,  after  a  long  struggle 
to  save  the  badly  decayed  superior  first  molars  of  a  Miss, 
14  years  of  age,  he  determined  to  extract  them.  After 
three  months  the  girl  returned,  and  it  was  noticed  that  the 
superior  centrals  had  separated  one-eighth  of  an  inch.  He 
adds,  "  since  that  time  I  have  refused  to  extract  symmetri- 
cally in-growing  subjects." 

Where  there  is  disparity  in  size  between  the  two  jaivs,  and  two 
teeth  need  to  he  extracted  from  the  more  prominent  one,  it 
would  be  a  serious  Tnistake  to  extract  the  corres- 
ponding teeth  in  the  other  and 
smaller  jaw. 

It  would  seem  almost  impossible  to  make  such  a  mistake, 
and  yet  that  it  has  been  made  time  and  again,  the  mouths 
we  are  called  upon  to  examine  often  bear  sad  evidence.  It 
occurs  through  lack  of  knowledge,  want  of  judgment,  or 
erroneous  teaching. 

When  those  of  long  practice  advise,  without  qualification, 
that  at  eleven  years  of  age  the  four  first  molars  should  be 
extracted,  it  is  scarcely  to  be  wondered  at  that  some  young 
practitioners  should  lose  confidence  in  their  own  better 
judgment  and  be  led  astray.  Harm  of  this  nature,  when 
once  done,  can  never  be  undone,  and  the  patient  is  injured 
beyond  remedy. 

Needless  extraction  should  be  carefully  guarded  against. 

It  is  our  object  to  save  and  improve,  not  to  destroy. 
Extraction  should  only  be  resorted  to  when  it  appears,  after 


PRINCIPLES    INVOLVED.  55 

careful  consideration,  to  be  the  best  or  only  way  of  accom- 
i^lisliing  the  object  in  view.  Ill-advised  extraction  of  the 
molars  or  bicuspids  has  often  been  the  cause  of  a  very 
serious  and  irremediable  form  of  deformity,  namely : — the 
separation  of  the  anterior  teeth,  leaving  unsightly  spaces 
between  them,  thus  depriving  them  of  their  natural  support 
and  leading  to  their  earlier  loss. 

When  teeth,  especially  the  first  molars,  are  extracted  at  a 
later  period  than  they  should  be,  leaving  a  space  that  the 
second  molars  cannot  occupy,  the  teeth  anterior  to  the  space 
will  fall  back  unless  prevented  by  the  occlusion.  If  this 
falling  back  pertains  only  to  the  bicuspids,  no  harm  will 
usually  result,  but  if  it  extends  to  the  anterior  teeth,  as  it 
may,  and  often  does,  the  result  will  be  disastrous.  In  this 
connection  we  cannot  lielj)  again  emphasizing  the  necessity 
for  the  removal  of  first  molars  (if  they  are  to  be  removed) 
before  the  second  molars  have  assumed  their  places  in  the 
arch. 


CHAPTER  VIII. 

PHYSIOLOGY    OP    TOOTH-MOVEMENT    AND    CHARACTER    OF 
TISSUES     INVOLVED. 

In  changing  the  position  of  teeth  in  the  act  of  regulating, 
the  surrounding  tissues,  both  hard  and  soft,  are  largely 
involved. 

In  order,  therefore,  to  properly  comprehend  the  philosophy 
of  tooth  movement,  it  is  necessary  to  understand  the  struc- 
tural character  of  these  tissues  and  the  physiological  changes 
that  take  place  in  them  while  a  tooth  is  being  moved. 

THE    ALVEOLAR    PROCESS. 

This  process,  as  its  name  implies,  is  not  a  separate  and 
distinct  bone,  but  an  outgrowth  from  another.  It  is  a  pro- 
visional structure  designed  to  support  the  teeth  in  position 
and  afford  lodgment  for  the  nutrient  vessels  leading  to  them. 
It  is  formed  upon  the  body  of  the  bones  of  the  jaw  as  the 
teeth  are  developed,  growing  with  them  until  they  are  fully 
formed,  and  then  remaining  while  they  remain. 

When  the  teeth  are  lost,  there  being  no  longer  any  special 
use  for  it,  most  of  this  process  is  absorbed  and  carried  away. 
In  early  infancy  little  alveolar  structure  exists,  but  it  is 
formed  co-ordinately  with  the  growth  of  the  deciduous  teeth 
and  remains  during  the  period  of  their  retention.  Should 
they  be  lost  before  their  successors  are  ready  to  appear,  the 
process  will  be  entirely  removed  by  absorption,  and  a  new 
one  formed  for  the  accommodation  of  the  permanent  teeth. 
Where,  however,  the  deciduous  teeth  are  gradually  shed  to 
make  way  for  their  successors,  the  process  is  not  entirely 
absorbed,  the  basal  and  unabsorbed  portion  serving  as  a 
foundation  upon  which  the  new  structure  is  formed. 

The  alveolar  process,  being  built  or  formed  upon  the  body 
of  the  maxillary  bones,  conforms  to  them  in  outline  and 

56 


PRINCIl'LES    INVOLVED.  57 

describes  the  same  curves.  In  depth  it  corresponds  to  the 
length  of  the  roots  of  the  teeth,  while  in  width  it  is  sufficient 
to  envelop  all  of  that  portion  of  the  teeth  located  below  the 
gum  line.  It  gradually  increases  in  width  as  it  approaches 
the  body  of  the  bone  upon  which  it  rests. 

It  consists  of  an  outer  and  inner  plate  united  at  intervals 
by  septa,  thus  forming  the  alveoli  for  the  accommodation  of 
the  roots  of  the  teeth.  In  structure,  the  process  is  not  com- 
pact, but  open  and  spongy,  somewhat  resembling  the  can- 
cellated structure  of  the  diploe  of  the  bones  of  tlie  cranium 
or  the  inner  portion  of  the  shafts  of  the  long  bones.  Its 
outer  or  cortical  layer  is  denser  and  harder  than  the  inner 
portion.  Its  cellular  structure,  while  giving  it  sufficient 
firmness  to  support  the  teeth  in  their  positions,  affords  op- 
portunity for  the  lodgment  and  passage  of  the  vessels  of 
nutrition  with  which  it  is  so  bountifully  supplied,  and 
allows  it  to  yield  or  bend  in  many  cases  when  pressed  upon 
by  the  moving  tooth  or  teeth.  This  is  especially  true  of  the 
outer  plate  of  the  superior  arch. 

Owing  to  its  peculiar  structure  and  its  great  vascularity, 
the  alveolus  is  readily  resorbed  under  the  stimulus  of  pres- 
sure and  again  readily  reproduced  behind  the  moving  teeth. 

THE    TEETH. 

Of  the  teeth  themselves,  but  little  need  be  said.  The 
student  is  familiar  with  their  number,  shape,  position  and 
structure.  Being  the  hardest  structures  of  the  human  body, 
the  application  of  any  force  necessary  to  move  them  will 
not  injuriously  affect  them  so  far  as  their  hard  tissues  are 
concerned. 

A  mechanical  difficulty  associated  with  their  moving  con- 
sists in  the  fact  that  their  crowns  are  round  and  smooth, 
thus  making  it  somewhat  difficult  to  apply  force  at  a  given 
point.  This  difficulty,  however,  has  been  overcome  by  the 
introduction  of  the  Magill  band. 

In  considering  the  moving  of  teeth,  the  fact  must  not  be 


58  ORTHODONTIA. 

■overlooked  that  while  the  crown  may  be  moved  consider- 
ably, the  movement  becomes  less  and  less  along  the  line  of 
the  root,  so  that  the  apex  is  moved  but  little.  This  is  due 
to  the  fact  that  force  can  only  be  applied  to  the  crown,  while 
the  apex  remains  almost  a  fixed  point  or  fulcrum.  In  the 
movement  of  a  tooth,  therefore,  whether  inward  or  outward, 
forward  or  backward,  the  crown  describes  the  arc  of  a  circle, 
the  centre  of  which  is  near  the  apex  of  the  root. 

Teeth  with  single  and  short  roots  can  be  moved  more 
readily  than  those  with  long  and  many  roots,  for  the  reason 
that  in  the  former  case  there  will  be  less  resistance  to  be 
overcome. 

THE    PULP. 

The  pulp  is  the  formative  organ  of  the  tooth,  and  after 
calcification  is  complete  it  remains  as  the  principal  source  of 
nutrient  supply  for  the  dental  tissues,  especially  the  dentine. 

It  is  composed  of  fibrous  connective  tissue,  containing  a 
delicate  system  of  lymphatics  together  with  numerous  nerve 
filaments  which  enter  through  the  apical  foramen.  Ramifi- 
cations of  minute  blood-vessels  are  noticeable  throughout 
its  whole  extent,  giving  color  to  the  organ  and  constituting 
its  vascular  system. 

It  bears  an  important  relation  to  the  teeth  in  their  move- 
ment, since  it  may  be  readily  devitalized  through  impru- 
dence or  lack  of  care.  Before  calcification  of  the  teeth  has 
been  completed  the  apical  foramen  is  large  and  easily  ac- 
commodates the  pulp  where  it  enters  the  tooth.  After  cal- 
cification is  complete  the  apical  foramen  is  small,  and  the 
pulp  at  this  point  is  in  consequence  greatly  reduced  in  size. 
In  the  movement  of  the  teeth  there  is  often  a  slight  me-- 
chanical  constriction  of  the  pulp  at  the  apex  due  to  the 
tipping  of  the  tooth  in  moving.  If  the  movement  be  rapid 
in  teeth  fully  calcified  (after  the  sixteenth  or  eighteenth 
year)  this  constriction  may  be  so  great  as  to  cause  death 
of  the  pulp  through  strangulation.  Before  complete  calci- 
fication this  is  not  likely  to  occur,  from  the  fact  that  when 


PRIXCII'LKS    INVOLVED.  59 

the    foramen   is   large   the   pulp    has   more   space   for   its 
accommodation. 

In  the  movement  of  a  tooth  in  the  direction  of  its  length 
the  pulj^  may  also  become  devitalized  through  excessive 
stretching.  This  has  occurred  at  times  in  drawing  down 
into  line  a  tooth  that  has  been  retarded  in  eruption.  In 
all  such  cases  care  must  be  exercised,  and  the  movement 
be  conducted  slowly. 

THE    PERICEMENTUM. 

The  pericementum  or  peridental  membrane  is  that  tissue 
which  envelops  the  root  of  the  tooth  and  fills  the  space  in- 
tervening between  it  and  the  alveolar  wall.  It  is  a  tough, 
strong  membrane,  composed  mainly  of  fibrous  connective 
tissue,  permeated  with  blood-vessels  and  nerve  fibres,  and 
containing  traces  of  a  lymphatic  system. 

It  is  strongly  adherent  to  the  alveolar  wall  of  the  socket 
on  the  one  hand,  and  to  the  cementum  of  the  tooth  on  the 
other,  its  adherence  being  due  to  the  extension  of  its  fibres 
into  both  the  bone  and  the  cementum.  These  fibres,  ac- 
cording to  Prof.  Black,*  "  are  wholly  of  the  white  or  inelastic 
connective  tissue  variety,"  and  the  apparent  elasticity  of  the 
membrane  is  due  to  the  passage  of  most  of  the  fibres  from 
cementum  to  wall  in  an  oblique  direction,  in  such  a  way  as 
to  "  swing  the  tooth  in  its  socket." 

This  membrane  is  the  formative  organ  of  the  cementum 
of  the  tooth,  and  also  assists  in  building  the  walls  of  the 
alveoli. 

The  cells  concerned  in  the  building  of  the  bony  walls  are 
known  as  osteoblasts,  and  those  forming  the  cementum  are 
designated  cementoblasts.  After  these  cells  have  performed 
their  normal  function,  they  become  encapsuled  and  form 
part  of  the  tissue  they  were  instrumental  in  building. 

When  re-formation  of  tissue  is  demanded,  as  in  the  thick- 
ening  of  the  alveolar  wall,  or  in  increasing   the   normal 

*  Dental  Eeview,  vol.  I. ,  p.  240. 


60  ORTHODONTIA. 

amount  of  cementum  at  various  points  under  certain  con- 
ditions, new  cells  are  originated  to  perform  the  work.  In 
the  moving  of  a  tooth  the  activity  of  these  new  cells  is  at 
once  manifested  in  the  formation  of  alveolar  tissue  to  fill 
the  space  caused  by  the  advancing  tooth. 

Beside  these  cells  of  construction  and  repair,  the  perice- 
mentum also  contains  cells  that  might  well  be  called  cells  of 
destruction.  They  are  the  osteoclasts  or  cementoclasts,  and 
their  function  is  to  break  down  or  absorb  the  cemental  or 
osseous  tissues  when  nature  calls  for  such  action. 

In  the  correction  of  irregularities  these  cells  perform 
valuable  service  in  removing  bony  tissue  in  front  of  the 
moving  tooth. 

The  pericementum  is  thickest  in  childhood,  when  the 
sockets  or  alveoli  are  of  necessity  considerably  larger  than 
the  roots  of  the  teeth  which  they  contain.  With  advancing 
age  both  cementum  and  the  alveolar  walls  are  increased  in 
thickness  by  slow  but  continuous  growth  until  the  perice- 
mentum is  greatly  reduced  in  thickness,  and  in  consequence 
the  diameter  of  the  roots  more  nearly  approximates  that  of 
the  alveoli  or  sockets. 

The  pericementum  possesses  a  variety  of  function  not  often 
met  with  in  any  single  tissue  of  the  human  system. 

It  retains  the  tooth  in  its  socket  and  acts  as  a  cushion  to 
prevent  injury  to  the  adjoining  bony  structures  from  hard 
and  violent  concussions  to  which  the  teeth  are  sometimes 
subjected. 

It  affords  accommodation  for  numerous  blood-vessels 
which  supply  both  the  teeth  and  alveolar  tissue  with  nutri- 
ent material,  and  for  the  branches  of  nerves  which  con- 
stitute it  the  sensory  organ  ^of  the  tooth,  so  far  as  tactual 
impress  is  concerned. 

It  is  the  organ  of  construction  and  repair  of  both  cemen- 
tum and  bone,  and  is  also,  on  occasion,  the  organ  of  destruc- 
tion of  either  or  both  of  these  tissues. 


PRINCIPLES    INVOLVED.  61 

PHYSIOLOGICAL    ACTION    IN    THE    MOVEMENT    OF    TEETH. 

In  the  movement  of  teeth,  one  or  both  of  two  changes 
take  place.  One  is  the  absorption  of  alveolar  tissue  on  the 
advancing  side  of  the  tooth,  and  its  reformation  on  the  oppo- 
site side,  and  the  other  is  a  bending  of  a  portion  or  the 
whole  of  the  alveolar  process  surrounding  the  moving 
teeth.  The  former  is  the  principal  action  that  takes  place 
in  the  moving  of  a  single  tooth,  and  the  latter  the  chief  one 
involved  in  the  movement  of  a  number  of  teeth  in  the  same 
region,  as  in  the  widening  or  expansion  of  the  arch. 

When  force  is  exerted  upon  a  single  tooth  for  the  purpose 
of  moving  it,  the  first  effect  produced  is  the  compression  of 
the  pericementum  between  the  tooth  and  alveolar  wall  on 
the  advancing  side,  and  the  stretching  of  the  same  mem- 
brane on  the  opposite  side.  In  the  compression  of  the 
membrane  the  blood  supply  is  partly  cut  off,  and  the  nerves, 
by  their  irritation,  create  a  sensation  of  pain,  which  is  soon 
obliterated  by  the  semi-paralysis  brought  about  by  continued 
pressure.  At  the  same  time  this  irritation  stimulates  and 
hastens  the  development  of  the  osteoclasts  which  at  once 
begin  the  work  of  breaking  down  and  absorbing  that  por- 
tion of  the  socket  pressed  upon. 

Bony  tissue  being  thus  removed,  accommodation  is  made 
for  the  advancement  of  the  tooth,  which  at  once  takes  place. 
Under  continued  pressure  this  action  is  renewed  again  and 
again  until  the  tooth  has  reached  its  intended  position. 
While  this  is  taking  place  on  the  advancing  side,  quite  an 
opposite  condition  prevails  on  the  side  from  which  advance- 
ment has  taken  place.  There  the  fibrous  tissue  of  the  peri- 
cementum has  been  subjected  to  extreme  tension,  greater 
room  has  been  jDrovided  for  the  accommodation  of  the 
nutrient  vessels,  and  osteoblasts  have  been  developed  for 
the  formation  of  bony  material  to  add  to  the  alveolar  wall 
and  thus  close  the  space  caused  by  the  movement  of  the 
tooth.  While  these  processes  of  absorption  and  reproduc- 
tion on  opposite  sides  of  the  tooth  have  been  going  on  coin- 


62  ORTHODONTIA. 

cidently,  their  results  have  been  very  unequal,  for  the 
absorption  of  bone  is  a  far  more  rapid  process  than  its 
formation. 

During  the  entire  time  of  moving,  and  for  a  long  time 
afterward,  the  tension  of  the  pericementum  on  the  free  side 
of  the  tooth  is  kept  up  to  such  an  extent  that  were  the  force 
of  pressure  or  retention  removed,  the  tooth  would  at  once 
be  drawn  partly  back  into  the  space  created  by  its  move- 
ment. 

The  tendency  is  only  finally  overcome  after  the  deposit  of 
ossific  matter  in  the  alveolar  socket  has  been  sufficient  to 
allow  the  pericementum  to  resume  its  normal  thickness  on 
that  side  of  the  tooth,  when,  by  virtue  of  the  removal  of  the 
tension  and  the  support  of  the  new  bony  tissue,  the  back- 
ward movement  of  the  tooth  will  no  longer  be  possible. 

While  this  process  of  reparative  construction  has  been 
going  on,  the  structures  about  the  opposite  side  of  the  tooth 
have  been  adjusting  themselves  to  the  new  condition.  The 
pressure  upon  the  tooth  having  ceased,  no  more  bone  is 
absorbed ;  any  injury  inflicted  upon  the  pericementum  by 
its  continued  compression  is  repaired  ;  the  nerves  and  blood- 
vessels resume  their  normal  functions,  and  the  tooth  in  its 
new  position  becomes  a  far  more  useful  member  of  the 
dental  organism  than  it  had  been. 

When  a  number  of  adjacent  teeth  are  moved  in  the  same 
direction,  especially  outward  in  the  superior  arch,  or  out- 
ward in  the  anterior  portion  of  the  lower  arch,  and  inward 
in  the  230sterior  portion  of  the  same  jaw,  a  distinct  bending 
of  the  alveolar  process  takes  place.  This  is  evidenced  by 
the  rapidity  with  which  the  movement  takes  place  (which 
is  far  greater  than  the  slow  process  of  absorption  would 
admit  of),  and  also  by  the  fact  that  after  the  movement  is 
completed  the  process  is  not  perceptibly  thinner  on  the  ad- 
vancing side  or  thicker  on  the  retreating  side  of  the  teeth 
than  it  was  in  the  beginning.  This  flexibility  of  the  process 
is  due  to  its  incomplete  calcification  at  the  age  when  opera- 


PRINCIPLES    IXVOLVKD.  63 

tions  for  irregularit}^  are  usually  undertaken.  That  the 
alveolar  plate  pressed  upon  should  yield  is  more  easily 
■comprehended  than  that  the  opposite  one  sliould  follow,  but 
the  septa  uniting  the  two  being  similar  in  semi-cartilaginous 
strength  and  elasticity  probably  draw  the  one  plate  after 
the  other  as  the  movement  takes  place. 

This  flexibility  of  the  alveolar  process  early  in  life  is  an 
important  aid  in  the  movement  of  teeth  in  that  it  both 
hastens  and  simplifies  the  operation,  but  it  should  not  be 
presumed  upon  or  too  great  advantage  taken  of  it,  for  if  an 
attempt  be  made  to  carry  it  beyond  normal  limits,  the  max- 
illary bones  will  be  liable  to  separate  along  the  sutural  line, 
and  the  central  incisors  be  spread  apart  in  consequence. 


PART    II. 

CHAPTER  I. 

MATERIALS   AND   METHODS. 

\ 

EXAMINATION    OF    THE    MOUTH. 

When  a  case  of  irregularity  presents  for  treatment,  the 
first  requirement  is  a  careful  examination  of  the  mouth  and 
teeth. 

In  conducting  this  examination  it  is  necessary  to  note 
the  position  of  the  teeth,  their  relation  to  one  another, 
their  occlusion  with  those  of  the  opposite  jaw,  the  relative 
size  and  shape  of  both  arches,  the  size,  character  and  con- 
dition of  the  teeth,  the  age  and  general  health  of  the  pa- 
tient, the  harmony  or  inharmony  of  the  features  and  the 
facial  expression. 

A  careful  consideration  of  all  these  points  will  enable  us 
to  decide : — 

1st.  What  is  desirable. 

2nd.  Whether  it  can  be  done. 

3rd.  If  possible,  how  it  can  best  be  accomplished. 

After  this  preliminary  examination,  our  opinion  of  the 
case  should  be  given  the  patient  or  parent  accompanied  by 
a  plain  statement  of  the  difficulties  of  the  case,  if  such  exist, 
the  probable  time  that  will  be  required  for  correction,  and 
an  approximate  estimate  of  the  cost.  To  avoid  any  possible 
misapprehension  the  patient  should  also  be  informed  that 

64 


MATERIALS    AND    METHODS.  65 

the  appliances  will  cause  some  annoyance  and  possibly  some 
pain,  and  that  patience,  endurance  and  perseverance  will  be 
necessary  on  his  or  her  part  to  enable  us  to  accom})lish  a 
satisfactory  result. 

It  should  also  be  mutually  understood  that  the  parent  or 
patient  shall  assist  in  the  furtherance  of  the  work  by  seeing 
that  the  appliances  are  faithfully  worn,  that  all  the  instruc- 
tions are  carried  out,  and  that  the  patient  shall  punctually 
meet  all  appointments  that  may  be  made. 

Should  the  prognosis  of  the  case  prove  satisfactory  and  all 
of  the  above  conditions  be  agreed  to,  we  may  at  once  proceed 
with  the  treatment. 

IMPRESSION  AND  ARTICULATION. 

The  first  step  will  be  to  take  impressions  of  the  upper  and 
lower  teeth  from  which  to  secure  models  for  the  further  and 
more  exact  study  of  the  case. 

These  impressions  should  be  taken  with  some  material  that 
will  receive  a  sharp  imprint  and  not  materially  change  its 
shape  in  removal  from  the  mouth.  Either  Plaster  of  Paris  or 
ModeUing  Composition  (Stent's  or  Godiva)  will  give  satis- 
factory results,  but  as  the  former  can  only  be  removed  from 
the  mouth  by  being  broken  into  many  pieces  the  latter  is  gen- 
erally preferred.  In  selecting  the  impression  cups,  those 
known  as  flat-bottom  cups  should  be  chosen,  on  account  of 
the  better  accommodation  they  afford  for  the  crowns  of  the 
teeth.  The  cups  should  in  all  cases  be  large  and  deep 
enough  to  allow  for  a  sufficient  quantity  of  the  material 
along  the  outer  rim  to  enable  a  perfect  impression  to  be 
taken  of  the  labial  and  buccal  surfaces  of  the  teeth,  and  as 
much  of  the  gum  above  them  as  possible.  Figs.  11  and  12 
represent  cups  of  this  character  with  high  sides,  devised  by 
Dr.  Angle  for  the  taking  of  plaster  impressions,  but  they 
answer  quite  as  well  for  Modelling  Compound. 


66 


ORTHODONTIA. 


A  proper  quantity  of  the  composition  having  been  softened 
by  dry  heat  or  in  hot  water,  it  is  placed  and  properly  shaped 
in  the  j)reviously  warmed  cup  and  rapidly  introduced  into 
the  mouth. 

In  taking  an  impression  of  the  upper  jaw  the  mouth 
should  be  kept  well  open  so  that  the  teeth  may  not  come  in 
contact  with  the  material  before  the  proper  time  and  thus 
mar  the  surface.     When  the  cup  with  its  contents  has  been 


Figs.  11  and  12. — Angle's  Impression  Cups  for  Irregularities. 

placed  as  far  back  as  necessary,  and  immediately  beneath 
the  teeth,  it  should  be  brought  up  into  position  with  a 
straight  and  steady  movement.  Once  there,  it  should  be 
firmly  held  while  a  finger  is  introduced  to  force  forward 
into  position  the  portion  of  material  that  has  escaped  at 
the  rear  of  the  cup,  after,  which  all  that  portion  along  the 
outer  rim  should  be  i^ressed  against  the  teeth  and  gums 
from  molar  to  molar. 


MATERIALS    AND    METHODS. 


07 


In  this  position  it  must  he  held  until  it  has  become  so 
hard  that  a  finger  nail  will  scarcely  indent  it,  when  it  should 
be  carefully  removed.  The  hardening  is  best  hastened  by  a 
stream  of  cold  water  from  a  syringe,  or  by  the  renewed 
application  to  the  cup  of  small  sponges  or  napkins  dipped 
in  ice  water  as  suggested  by  Prof.  Newkirk. 

In  taking  an  impression  of  the  lower  jaw  the  same  general 
method  is  followed,  and  after  the  cup  is  in  position  all  the 
surplus  material  around  both  the  outer  and  inner  rims 
should  be  pressed  into  place  with  the  finger. 

The  models  obtained  from  impressions  taken  in  this  man- 
ner will  be  sufficiently  accurate  to  give  us  a  good  represen- 
tation of  both  the  buccal  and  lingual  surfaces  of  the  teeth, 
sonecfessary  to  a  proper  study  of  the  case. 

Impress- 
ions taken  in 
plaster  are 
the  most  ac- 
curate in  de- 
tail, but  the 
com  pound 
gives  us  all 
the  accuracy 
we  need  in 
models  for 
regulating. 

During  the 
same  sitting 
at  which  the 


Fig.  13. 


The  Author's  Wire  Articulator. 


impressions 

are  taken,  the 

manner     in 

which  the  teeth  occlude  should  be  observed  and  recorded, 

so  as  to  enable  us  to  place  the  models  in  proper  relation 

while  being  attached  to  the  articulator.     This  will  dispense 

with  the  necessity  for  taking  a  bite. 


68  ORTHODONTIA. 

All  inexpensive  and  excellent  articulator,  Fig.  13,  for  the 
mounting  of  models  of  irregularity,  is  made  from  brass  wire. 
The  upper  arms  and  coil  are  one  continuous  piece,  while  the 
lower  arms  are  formed  by  passing  another  piece  of  the  wire 
through  the  coil  and  bending  to  shape. 

The  articulator  is  so  slender  in  outline  that  after  the  models 
are  atttached  to  it  the  occlusion  of  the  inner  cusps  of  the 
teeth  may  be  as  readily  examined  as  that  of  the  outer  ones. 

With  the  models  properly  mounted  on  the  articulator,  our 
second  and  more  deliberate  study  of  the  case  may  be  carried 
forward  at  our  leisure. 

At  the  first  or  personal  examination  of  the  case,  we  are 
supposed  to  have  decided  upon  the  advisability  of  an  attempt 
at  correction,  and  also  upon  the  general  plan  we  ptirpose 
pursuing.  By  the  study  of  the  articulated  models  we  will  be 
enabled  to  decide  upon  the  details  of  the  work  and  the  kind 
of  appliance  that  should  be  used.  Both  studies  are  neces- 
sary, for  with  the  patient  in  the  chair  we  cannot  take  the 
time  to  map  out  the  proposed  work  in  detail,  while  an 
examination  of  the  models  alone  will  leave  us  without  a 
knowledge  of  many  important  characteristics  of  the  case  that 
can  only  be  gained  from  a  personal  examination. 

Articulated  models,  made  and  mounted  as  described,  are 
most  important  not  only  for  purposes  of  pre'sent  study,  but 
also  for  comparison  as  the  work  progresses.  Inasmuch 
as  they  represent  the  exact  condition  of  the  case  at  the 
beginning,  we  have  in  them  a  means  of  ascertaining  what 
advancement  has  been  made  at  any  stage  of  the  operation, 
whether  the  different  movements  are  proceeding  satisfac- 
torily, and  finally,  when  the  ojDeration  is  completed,  of 
observing  just  how  much  change  has  been  effected.  An 
ocular  comparison  is  of  some  value,  but  a  mathematical  one 
'  made  with  calipers  and  rule  is  far  more  exact  and  satisfac- 
tory. 


MATERIALS    AND    METHODS.  69 

STUDY    OF    CASE    FROM    ARTICULATED    MODELS. 

Tlie  study  of  the  case  may  be  either  a  simple  or  difficult 
one,  according  to  the  conditions  and  requirements  involved. 
Thus,  the  movement  of  a  single  tooth  will  only  involve  the 
consideration  of  providing  accommodation  for  it  in  the  arch 
and  the  manner  of  applying  force  to  bring  it  into  position, 
whereas  when  a  number  of  teeth  in  different  locations  are 
to  be  moved,  each  pcrliaps  requiring  a  different  form  of 
movement,  we  will  have  to  decide  whether  we  can  and  should 
produce  all  of  these  movements  with  one  appliance  at  one 
time,  or  whether  it  would  be  best  to  produce  each  move- 
ment separately  and  possiljly  with  different  appliances.  If 
the  latter,  we  will  have  to  determine  which  should  be  accom- 
plished first,  which  next,  and  so  on. 

For  instance,  where  the  entire  upper  arch  is  to  be  expanded 
to  make  room  for  outstanding  cuspids,  we  will  have  three 
different  operations  to  perform  ;  the  side  teeth  must  be  moved 
laterally,  the  anterior  ones  forward  and  the  cuspids  inward 
into  line.  To  produce  all  of  these  movements  at  the  same 
time  with  one  appliance  would  be  impossible  from  the 
nature  of  the  case,  therefore  they  will  have  to  be  performed 
separately,  and  usually  in  the  order  in  which  they  have 
been  named.  In  attempting  to  produce  many  movements 
with  one  appliance  we  often  defeat  our  object,  although 
occasionally,  where  the  movements  to  be  produced  are  of 
opposite  character,  we  may  advantageously  play  one  against 
the  other. 

Where  they  are  of  the  same  character,  or  nearly  so,  too 
much  should  not  be  attempted  at  one  time,  for  the  loosen- 
ing of  many  teeth  will  be  liable  to  make  our  anchorage 
unstable,  in  which  case  we  would  have  to  suspend  all  opera- 
tions until  some  of  the  teeth  again  became  firm. 

Having  decided  upon  the  order  in  which  the  movements 
should  take  place,  we  have  two  other  important  points  to 
determine. 


70  ORTHODONTIA. 

Amount  of  power  required. — This  will  be  determined  largely 
by  the  age  of  the  patient  and  the  character  of  the  teeth  and 
process.  As  j^reviously  stated,  early  in  life,  before  the 
j^rocess  has  become  fully  calcified,  the  teeth  can  be  moved 
more  rapidly  than  at  a  later  period,  and  less  power  will  be 
required  to  accomplish  it;  so  also,  in  patients  of  the  same 
age,  the  teeth  of  one  will  be  more  readily  moved  than  those 
of  the  other.  This  is  due  both  to  the  relative  length  of  the 
roots  and  the  resistance  of  the  alveolar  walls,  and  as  we  can- 
not judge  of  the  lengths  of  the  roots  from  the  appearance 
of  the  crowns  alone,  we  have  to  form  our  opinion  in  the 
matter  from  the  general  conditions. 

Observation  has  shown  that  teeth  with  large  crowns,  situ- 
ated in  large  and  firm-looking  jaws,  usually  have  long  roots  ; 
whereas,  smaller  teeth,  associated  with  thin  and  more  deli- 
cate processes,  have  shorter  roots. 

Therefore,  considering  the  age  of  the  patient  and  the 
appearance  of  the  teeth  and  processes,  we  can  at  least  decide 
whether  the  amount  of  force  to  be  applied  should  be  great 
or  little. 

Manner  of  applying  power. — Among  the  many  appliances 
or  substances  for  yielding  power  in  the  moving  of  teeth,  the 
practitioner  has  a  range  of  choice  from  the  screw  '^ith  its 
directness  and  power,  to  the  silk  ligature  with  its  gentle 
traction. 

Between  these  two  extremes  we  have  materials  that  will 
yield  us  force  in  any  desired  degree.  Selecting  the  one 
which  seems  best  suited  to  the  case,  we  must  next  decide 
upon  the  most  advantageous  manner  of  using  or  apply- 
ing it. 

There  are  two  general  methods  of  securing  the  power- 
producing  appliances  in  the  mouth.  One  is  the  use  of  a 
plate  of  some  kind  to  which  attachments  can  be  made,  and 
the  other  is  the  plan  of  attaching  the  appliances  to  the 
natural  teeth  in  such  a  way  as  to  dispense  with  the  wearing 
of  a  plate. 


MATERIALS    AND    METHODS.  71 

In  certain  methods  of  regulating,  such  as  Angle's,  Jack- 
son's and  Patrick's,  no  plate  is  used;  while  in  others,  such 
as  Coffin's,  a  plate  is  invariably  used  for  attachment  and 
security.  Farrar  advocates  the  use  of  a  plate  onl}^  in  excep- 
tional cases.  Each  manner  has  its  advantages  and  disad- 
vantages.    In  the  use  of  a  plate,  we  have  as  advantages : — 

Its  convenience  and  adaptability. — Covering  a  large  surface, 
it  affords  opportunity  for  the  attachment  of  the  immediate 
power-yielding  appliance  in  any  position  and  at  any  angle, 
and  permits  the  same  to  be  altered  or  changed  with  very 
little  trouble.  It  also  protects  the  soft  tissues  from  any  pos- 
sible injury  which  might  result  from  the  slipping  or  impinge- 
ment of  other  appliances  upon  them.  Indeed,  in  many  cases, 
a  plain  rubber  or  metal  plate  covering  the  roof  of  the  mouth 
and  not  having  any  appliances  attached  to  it,  is  used  simply 
for  the  protection  of  the  gums  during  the  operation  of  regu- 
lating. 

Its  distribution  of  the  power  of  resistance. — Touching  all  or 
nearly  all  of  the  teeth  not  being  operated  upon,  it  compels 
each  one  to  bear  its  part  in  offering  resistance  to  the  power 
used  for  the  movement  of  certain  teeth,  and  in  this  way 
brings  more  teeth  into  use  as  points  of  resistance  than  can 
possibly  be  done  by  any  other  method. 

Its  simplicity  of  construction  and  the  facility  it  affords  for 
adjustment  and  alteration. 

The  disadvantages  pertaining  to  the  employment  of  a 
plate  as  an  aid  in  regulating,  are : — 

Its  uncleanliness. — Inasmuch  as  a  plate  comes  in  contact 
with  so  much  tooth  surface  at  the  necks  and  elsewhere,  it 
offers  special  opportunity  for  the  accumulation  of  debris.  In 
plates  that  are  removable  by  the  patient,  this  may  be  largely 
avoided  by  frequent  cleansing,  but  observation  has  shown 
that  the  majority  of  patients  are  either  so  careless  or  indif- 
ferent in  regard  to  the  matter,  that  a  clean  regulating  plate 
is  seldom  seen.     In  plates  so  constructed  or  arranged  that 


^     72  ORTHODONTIA. 

only  the  dentist  can  remove  them,  the  uncleanliness  of  the 
plate  and  consequent  danger  of  mjury  to  the  teeth  is  greatly 
increased 

The  frequent  appointments  necessary. — In  the  class  of  plates 
last  alluded  to,  it  is  absolutely  important  that  they  be  removed 
and  cleansed  at  least  once  in  every  forty-eight  hours.  This 
requires  such  frequent  visits  on  the  part  of  the  patient  and 
the  expenditure  of  so  much  valuable  time  on  the  part  of  the 
operator,  as  to  constitute  a  serious  objection  to  the  use  of 
such  plates  where  they  can  at  all  be  dispensed  with. 

When  plates  are  not  used,  appliances  are  usually  attached 
directly  to  certain  teeth  which  serve  as  anchorages.  Such 
attachment  is  generally  secured  by  means  of  bands  or 
collars  encircling  the  teeth  and  cemented  to  them ;  or,  in 
other  cases,  by  having  the  bands  simply  passed  around  the 
teeth  of  attachment  and  drawn  tight  by  means  of  screws  or 
clamps. 

The  advantages  of  appliances  attached  to  the  teeth  in  this 
way  are : — 

1st.  The  leaving  of  the  roof  of  the  mouth  uncovered,  thus 
affording  more  room  for  the  movements  of  the  tongue. 

2nd.  Their  greater  cleanliness,  because  they  touch  the 
teeth  at  few  points,  and  thus  furnish  good  opportunity  for 
thorough  cleansing  with  the  brush. 

3rd.  Not  needing  to  be  removed,|fewer  visits  to  the  dentist 
are  necessary,  thus  effecting  a  great  saving  in  time  and  labor. 

The  only  objection  that  could  be  raised  against  this  man- 
ner of  attachment  is,  that  fewer  teeth  are  brought  into  service 
in  anchoring  the  appliance,  but  this  objection  may  be  largely 
overcome  by  making  such  extensions  or  additions  to  a  band 
as  to  cause  teeth  adjoining  the  banded  ones  to  bear  their 
part  in  offering  resistance.  Two  extensions  of  this  character, 
as  used  in  the  author's  practice,  may  be  seen  in  cuts  14 
and  15. 

In  Fig.  14  a  bicuspid  is  banded,  and  to  the  band  on  the 
buccal  side  is  soldered  a  strip  of  platinized  gold  long  enough 


MATERIALS    AND    METHODS. 


73 


Fig.  15. 


to.  reach  to  and  rest  upon  the  adjoining  teeth,  causing  them 
to  bear  their  part  in  affording  the  needed  resistance.     We 

thus  get  the  resistance  of 
^_„-.l-_  ■  three  teeth  with  the  use  of 

a  single  band. 

In  Fig.  15  an  extension 
strip  of  gold  is  soldered  to 
a  bicuspid  band,  in  order 
to  obtain  tiie  additional 
resistance  ol'  the  adjoining 
molar. 

Dr.  Anglo  recommends 
the  banding  of  two  adjoin- 
ing teeth  and  having  these 
bands  united  before  being 
placed  in  position,  as  .shown 
in  Fig.  16.     He  claims  that 
by  this  method  the  resist- 
ance is  greatly  increased, 
for    the   anchor    teeth    to 
move   at  all  would   have 
to  move  bodily  forward  in 
an  upright  position  instead 
of  tipping.     So  much  re- 
sistance to  this  form  of  movement 
would    be   offered    by   the   mass   of 
alveolar  tissue  involved,  as  to  make 
it  almost  impossible  of  accomplish- 
ment. 

When  bands  are  placed  around 
teeth  and  secured  by  some  mechani- 
cal device,  they  never  can  fit  the 
teeth  so  accurately  as  to  avoid  spaces  for  the  accumulation 
of  food  and  saliva.  The  fermentation  of  the  particles  of 
food,  and  the  acidity  of  the  saliva  in  a  state  of  rest,  will 
soon  injuriously  affect  even  good  tooth  structure. 


Fig.  16. 


Stationary  Anchorage 
(Angle.) 


74  ORTHODONTIA. 

This  can  only  be  prevented  by  the  employment  of  some 
material  that  will  perfectly  fill  the  space  between  the  band 
and  the  tooth,  therefore  all  bands  passing  around  and  encir- 
cling the  teeth,  in  order  to  be  harmless,  should  be  cemented 
in  place  with  phosphate  of  zinc. 


CHAPTER  II. 
APPLIANCES. 

MATERIALS    AND    THEIR    USES. 

During  the  study  of  the  case,  after  we  have  decided  upon 
the  amount  and  kind  of  power  we  wish  to  apply  in  order  to 
produce  the  desired  movements,  we  will  have  to  consider  the 
different  materials  at  our  disposal  in  order  that  we  may  select 
from  them  the  ones  best  suited  to  our  purpose  for  the  case  in 
hand. 

PLATINUM    AND    ITS    ALLOYS. 

Platinum  on  account  of  its  tastelessness,  its  non-oxida- 
bility  and  its  harmonious  color,  should  constitute  it  one  of 
the  best  metals  for  use  in  the  mouth.  Its  extreme  pliability 
and  softness,  however,  greatly  limit  its  usefulness,  so  that  it 
can  be  used  only  where  these  latter  qualities  do  not  interfere 
with  its  employment. 

It  is  chiefly  used  in  the  construction  of  bands  that  are  to 
be  cemented  to  the  teeth  to  serve  as  anchorage  for  appli- 
ances or  to  form  parts  of  retaining  fixtures. 

In  combination  with  other  metals,  in  the  form  of  alloj'^s, 
its  greatest  usefulness  is  developed. 

IRIDIO-PLATINUM. 

This  alloy,  combining  the  color  and  purity  of  platinum 
with  the  hardness  and  stiffness  of  iridium,  is  useful  for  bands, 
bars  and  wires,  in  connection  with  regulating  appliances 
where  platinum  alone  would  not  be  available  on  account  of 
its  softness. 

PLATINIZED    GOLD. 

Gold  in  a  pure  state,  or  alloyed  with  silver  or  copper,  does 
not  possess  the  stiffness  necessary  for  its  use  in  the  form  of 

75 


76  ORTHODONTIA. 

bars,  springs  or  accessories,  where  great  resistance  or  elas- 
ticity is  requisite,  but  when  alloyed  with  about  five  per  cent. 
of  platinum  it  attains  a  degree  of  elasticity  second  only  to 
steel.  In  this  form  it  is  one  of  our  most  useful  materials 
for  even  the  heat  of  soldering  does  not  rob  it  of  its  elastic 
quality. 

This  alloy  of  gold  can  be  purchased  in  the  dental  depots 
in  plate  of  any  thickness  and  in  wire  of  any  form  or  size. 
When  used  for  the  construction  of  screws  or  supports,  its 
stiffness  is  the  quality  taken  advantage  of,  while  in  the  form 
of  levers  or  bows  its  elasticity  constitutes  its  chief  excellence. 

PLATINIZED    SILVER. 

This  alloy,  though  long  and  favorably  known  in  England, 
has  never  been  extensivel};^  used  in  America.  It  is  prepared 
for  the  market  in  the  form  of  plate  and  wire  of  every  gauge. 
In  the  form  of  plate  it  is  largely  used  abroad  as  a  base  for 
artificial  dentures,  especially  small  partial  pieces,  while  the 
wire  is  used  as  a  support  for  the  Ash  tube-teeth  and  other 
purposes. 

The  alloy  is  composed  of  one  part  of  platinum  to  two  of 
silver.  Its  stiffness  and  elasticity  is  but  little  inferior  to 
platinized  gold,  while  its  cost  is  about  one-half  that  of  gold. 
It  can  be  rolled,  bent  or  fashioned  in  any  form  and  may  be 
soldered  with  the  highest  grades  of  gold  solder. 

In  the  form  of  wire  the  author  has  found  it  very  useful  in 
the  construction  of  bows  for  the  attachment  of  rubber  bands 
or  ligatures  to  draw  teeth  in  any  direction,  and  for  parts  of 
retaining  appliances  where  inconspicuousness  is  desirable. 

Its  non-oxidability  is  also  a  feature  of  considerable  value. 

GERMAN    SILVER. 

This  improperly  named  alloy,  composed  of  copper,  zinc 
and  nickel,  is  frequently  employed  in  the  construction  of 
regulating  appliances,  on  account  of  its  stiffness  and  inex- 
pensiveness.     While  it  may  be  regarded  as  a  base  com- 


MATERIALS    AND    METHODS.  77 

pound,  its  baseness  is  of  so  high  a  grade  that  it  may  be  used 
without  fear  of  harm  to  the  soft  tissues  or  the  general  system. 
Prof's.  Angle  and  Matteson  use  it  very  largely  in  the  con- 
struction of  their  appliances,  and  the  author  has  made  fre- 
quent use  of  it  without  ever  noticing  an}'  deleterious  effects. 
Its  valuable  qualities  are  many,  and  the  ease  with  whicli  it 
may  be  electro-gilded  furnishes  us  with  a  means  of  improving 
its  appearance. 

GOLD. 

Gold,  in  its  non-elastic  condition,  has  been  and  probabl}' 
always  will  be  one  of  the  most  useful  of  the  metals  for  the 
construction  of  parts  of  regulating  appliances.  Its  softness, 
adaptability  and  strength  are  all  qualities  of  the  greatest 
value  and  render  it  serviceable  in  numberless  ways.  To 
preserve  its  purity,  and  as  far  as  possible  to  prevent  oxida- 
tion, it  should  never  be  used  of  a  carat  less  than  20  or  22. 

STEEL. 

This  metal  has,  the  same  desirable  qualities  of  firmness 
and  elasticity  that  are  found  in  platinized  gold,  and  possesses 
them  in  a  higher  degree,  so  that  it  is  used  in  preference  to 
the  former  metal  where  greater  power  is  needed. 

There  are  two  disadvantages,  however,  connected  with  its 
use : — one  is,  that  it  cannot  be  highly  heated  (as  in  solder- 
ing) without  destroying  its  temper ;  and  the  other,  that  it 
oxidizes  so  readily  when  in  contact  with  the  fluids  of  the 
mouth.  This  latter  objection  is  largely  overcome  by  electro- 
plating it  with  gold,  a  full  description  of  which  method  will 
be  found  in  the  latter  part  of  this  volume.  It  is  used  prin- 
cipally in  the  construction  of  jack-,  and  other  screws  and  as 
wire  in  the  form  of  bows,  levers  and  springs. 

VULCANITE. 

Soon  after  the  introduction  of  vulcanite  as  a  base  for  arti- 
ficial teeth,  its  qualities  of  adaptability,  strength  and  elas- 
ticity were  recognized  and  utilized  in  the  construction  of 


78  ORTHODONTIA. 

appliances  for  regulating.     By  its  use  we  secure  advantages 
that  could  not  be  so  readily  gained  from  other  substances. 

Used  either  to  produce  pressure  by  its  own  elasticity,  or  as 
a  medium  for  the  attachment  of  other  power-producing 
appliances,  it  has  been  one  of  the  most  commonly  employed 
materials  for  the  construction  of  regulating  appliances. 

COMPRESSED     WOOD. 

The  use  of  this  substance  is  very  old.  Before  the  intro- 
duction of  either  soft  or  vulcanized  rubber,  the  quality  of  the 
expansion  of  compressed  wood  under  moisture  was  employed 
in  lieu  of  elasticity. 

It  was  chiefly  used  in  the  form  of  small  sections  placed 
between  a  silver  or  gold  plate  and  the  teeth  to  be  moved,  a 
suitable  slot  or  socket  for  its  retention  having  been  formed 
in  the  plate. 

In  this  way  it  is  no  longer  used,  other  materials  possessing 
superior  qualities  having  superceded  it. 

The  author  occasionally  finds  great  advantage  from  the 
use  of  compressed  wood  in  the  separation  of  teeth  for  the 
accommodation  of  some  malposed  tooth,  where  the  existing 
space,  though  not  sufficient,  is  still  too  great  to  admit  of  the 
use  of  elastic  rubber. 

In  such  cases  it  is  his  custom  to  cut  a  cross-section  from 
some  compressible  wood,  such  as  cotton-wood,  a  little  larger 
than  the  space  it  is  to  occupy.  This  is  compressed  in  the 
direction  of  the  length  of  the  fibre  by  means  of  a  hammer, 
after  which  it  is  notched  at  each  end  to  fit.  the  convex  sur- 
faces of  the  teeth  to  be  moved.  Upon  being  placed  in 
position  its  expansion  by  the  absorption  of  the  fluids  of  the 
mouth  will  quickly  cause  the  movement  of  the  teeth.  In 
the  course  of  its  expansion  it  adapts  itself  accurately  to  the 
tooth  surfaces  and  thus  does  not  become  dislodged  or  slip 
from  its  position. 

SEA-TANGLE. 

This  is  one  of  the  newer  substances  introduced  into  the 
list  of  materials  that  are  of  service  in  regulating.     The  idea 


MATERIALS    AND    METHODS.  79 

of  its  use  was  borrowed  from  the  medical  fraternity,  who 
first  employed  it  for  distention  of  the  cervex  uteri.  It  is  a 
variety  of  sea-weed  botanically  known  as  laminaria,  that  has 
been  robbed  of  its  moisture  and  compressed  until  its  density 
is  about  equal  to  horn.  For  medical  use  it  comes  in  the 
form  of  a  cylindrical  tent  about  one-fourth  of  an  inch  in 
thickness  and  two  inches  in  length. 

This  is  the  only  form  in  which  it  has  been  placed  upon  the 
market.  In  the  presence  of  moisture  it  rapidly  expands  from 
two  to  three  diameters.  As  it  expands  only  in  the  direction 
of  its  width,  sections  from  it  must  be  so  cut  and  shajDed  as  to 
take  advantage  of  this  lateral  enlargement. 

In  regulating  it  may  be  employed  in  place  of  compressed 
wood,  and  like  it  is  used  to  produce  pressure  between  the 
unyielding  plate  and  the  tooth  to  be  moved.  A  place  for  it 
is  readily  provided  by  cutting  a  hole  or  socket  in  the  rubber 
plate  at  the  desired  point. 

Its  advantage  over  rubber  or  wood  lies  in  its  greater  ex- 
pansive properties  and  the  ease  with  which  it  can  be  secured 
in  place.  A  piece  of  suitable  size  can  be  placed  in  position 
and  the  plate  properly  secured  in  the  mouth  before  expan- 
sion begins. 

ELASTIC    RUBBER. 

The  resilience  of  elastic  rubber  was  early  recognized  as  a 
valuable  property  that  might  be  used  to  advantage  in  pro- 
ducing traction  upon  teeth  to  be  moved.  It  was  first  used 
in  the  form  of  strips  attached  at  either  end  by  ligature,  but 
since  the  introduction  of  rubber  tubing,  rings  or  bands  cut 
from  the  same  have  been  employed  instead.  Their  first 
employment  has  been  credited  to  Dr.  E.  G.  Tucker,  of  Bos- 
ton, about  the  year  1846. 

These  sections,  cut  from  the  smaller  sizes  of  French  rubber 
tubing,  are  now  in  almost  universal  use  in  connection  with 
other  appliances  for  regulating,  and  their  value  has  been 
greatly  enhanced  since  the  Magill  band  has  furnished  a 
better  means  for  their  attachment. 


80  ORTHODONTIA. 

Their  power,  though  great,  is  limited,  for  they  cannot 
exert  so  great  a  force  as  the  metals,  but  their  wide  range  of 
applicability  and  the  persistence  of  their  power  places  them 
among  the  most  valuable  adjuncts  of  regulating  devices. 

In  use,  their  tendency  to  slip  off  the  tooth  or  up  under  the 
gum  (which  constitutes  the  chief  objection  to  their  employ- 
ment) must  be  guarded  against  by  so  securing  them  that 
■change  of  position  will  be  impossible.  They  should  never 
be  permitted  to  rest  upon  or  touch  the  soft  tissues  at  any 
point. 

SILK    LIGATURES. 

The  contraction  of  silk,  linen  or  cotton  thread  in  contact 
with  moisture,  enables  us  to  make  use  of  it  where  the 
gentlest  tractile  power  is  desired.  Most  frequently  it  is 
employed  simply  as  a  ligature  in  attaching  some  appliance 
to  the  teeth,  but  it  has  often  been  used  to  advantage  in 
cases  where  teeth  were  to  be  moved  slowly  and  a  very  short 
distance.  Prof.  Peirce  employs  it  in  this  way  for  the  mov- 
ing of  certain  single-rooted  teeth,  as  described  in  Part  III. 
Its  gentle  power,  together  with  its  safety  and  simplicity,  will 
often  prove  the  very  qualities  we  desire  in  certain  simple 
operations. 

CHINA-GRASS    LINE. 

This  material  has  been  extensively  used  in  New  England 
for  ligatures  in  regulating,  being  preferred  for  that  purpose 
to  silk  or  cotton. 

It  is  the  Boehmeria  nivea  of  botanists,  and  more  commonly 
known  as  Ramie  or  Rhea  fibre,  and  is  the  material  from 
which  China-grass  cloths  are  manufactured.  It  is  stiff 
enough  to  be  threaded  with  a  pair  of  tweezers  between  the 
teeth  at  their  necks,  thus  avoiding  the  pain  of  forcing  a 
ligature  between  them  when  tender. 

It  is  non-elastic,  but  shrinks  greatly  without  softening 
when  moist,  thus  exerting  considerable  traction  without 
producing  j)ain. 


MATERIALS    AND    METHODS.  81 

QUALITIES  AN  APPLIANCE  SHOULD  POSSESS. 

In  selecting  a  form  of  appliance  from  among  the  many 
that  have  been  devised  by  writers  and  workers  in  this  field 
of  practice,  or  in  devising  one  to  suit  the  demands  of  the 
case  under  consideration,  it  will  be  well  to  consider  and  bear 
in  mind  the  qualities  any  appliance  should  possess  in  order 
to  render  it  most  effective. 

The  following  are  among  the  most  important  of  such 
qualities : — 

Efficiency. — The  first  requirement  of  any  device  is,  that  it 
shall  be  able  to  do  the  work  expected  of  it.  All  appliances 
are,  of  course,  devised  with  this  end  in  view,  but  the  attain- 
ment of  it  is  often  not  as  simple  a  matter  as  might  at  first 
appear.  Almost  every  case  has  associated  with  it  so  many 
features  and  peculiarities  claiming  consideration,  that  even 
with  the  greatest  care  and  thought  we  often  fail  to  apprehend 
or  grasp  each  individual  complication.  Some,  indeed,  are 
so  little  apparent  that  they  can  scarcely  be  recognized  in 
advance. 

For  this  reason  even  the  most  experienced  j^ractitioners 
will  at  times  devise  an  appliance  which,  though  seemingly 
meeting  all  the  requirements,  will,  when  brought  to  a  prac- 
tical test,  fail  to  accomplish  the  end  desired.  It  will  then 
have  to  be  altered,  or  perhaps  discarded  in  favor  of  some 
other  fixture  more  perfectly  adapted  to  the  requirements  of 
the  case. 

An  appliance  that  will  not  yield  the  results  we  desire,  or 
which  yields  them  in  an  imperfect  manner,  should  in  all 
cases  be  superseded  by  another. 

Simplicity. — A  complicated  device  is  in  nearly  all  cases  less 
efficient  than  a  simple  one.  Simplicity  is  a  cardinal  virtue 
in  all  matters  of  construction,  and  through  lack  of  it  about 
seventy-five  per  cent,  of  the  patents  granted  in  this  country 
prove  unprofitable. 

Far  greater  mechanical  ingenuity  is  displayed  in  an  effec- 
tive simple  device  than  in  a  complicated  one. 


82  ORTHODONTIA. 

Rapidity  of  action. — In  order  to  lessen  the  discomfort  of  the 
patient  and  to  conserve  the  time  of  both  patient  and  opera- 
tor, a  regulating  appliance  should  be  as  rapid  in  its  action 
as  is  consistent  with  physiological  conditions.  Too  rapid 
action  may  cause  suffering  to  the  patient  and  possibly  bring 
about  deleterious  results,  while  too  slow  action  will  prolong 
the  treatment  unnecessarily  and  possibly  cause  the  patient 
to  become  disheartened  and  abandon  the  treatment. 

Between  these  two  extremes  there  is  a  mean  in  which  the 
best  results  are  accomplished. 

All  regulating  appliances  are  at  best  a  source  of  some  dis- 
comfort to  the  patient.  A  foreign  body  in  the  mouth,  occu- 
pying a  certain  amount  of  space  and  thereby  interfering 
more  or  less  with  natural  functions,  cannot  fail  to  be  objec- 
tionable. In  order,  therefore,  to  lesson  his  discomfort  as 
much  as  possible,  we  should  try  to  devise  appliances  that 
will  occupy  no  more  space  than  is  necessary  and  also  have 
them  free  from  all  rough  projections.  Very  little  is  required, 
to  cause  abrasion  of  or  injury  to  the  soft  tissues  of  the  oral 
cavity,  and  when  once  caused  such  lesions  are  the  source  of 
much  pain. 

Least  interference  with  speech  and  mastication. — Most  patients 
apply  to  us  for  correction  of  irregularity  at  a  time  when  their 
education  is  in  progress.  Their  lessons  must  be  recited,  and 
their  enunciation  must  be  distinct  enough  to  be  understood 
by  the  teacher.  With  a  large  and  cumbersome  appliance  in 
the  mouth  it  would  prove  very  difficult  for  them  to  speak 
distinctly,  and  they  would  thus  be  placed  at  a  disadvantage. 

They  are  also  in  their  growing  age  when  the  body  needs 
an  abundance  of  nutritious  food  to  supply  the  demands  of 
the  various  tissues.  If  mastication  be  insufficient  through 
imperfect  occlusion  or  through  tenderness  of  the  teeth  caused 
by  a  bulky  fixture,  nutrition  will  be  inadequate  to  the  needs 
of  the  system. 

Such  conditions  can  and  ought  to  be  avoided  by  a  properly 
constructed  appliance. 


MATERIALS    AND    METHODS.  83 

Cleanliness. — The  cleanliness  of  any  appliance  will  depend 
both  upon  the  method  of  its  construction  and  the  care  that 
is  taken  of  it.  If  it  be  removable  so  that  the  patient  can 
take  it  out,  cleanse  and  reinsert  it,  there  ought  to  be  no 
difficulty  about  its  being  kept  clean.  The  patient  should  be 
instructed  to  remove  it  for  cleansing  at  night,  in  the  morn- 
ing, and  after  each  meal,  at  the  same  time  giving  the  natural 
teeth  a  thorough  brushing. 

A  good  plan  is  to  supply  the  patient  with  a  brush,  properly 
marked,  to  be  kept  in  the  office.  When  the  patient  appears 
and  the  appliance  is  removed,  tlie  operator  should  see  that 
both  plate  and  teeth  are  well  cleansed  in  his  presence.  This 
one  cleansing  he  will  be  sure  of,  though  he  may  not  be  cer- 
tain of  the  others.  The  same  plan  is  pursued  with  plates 
or  appliances  that  can  onl}'  be  removed  by  the  operator. 
Where  appliances  are  of  such  character  that  they  seldom 
need  to  be  disturbed,  the  patient  should  be  taught  to  take  a 
quantity  of  water  in  the  mouth,  and  then  using  the  lips  and 
cheeks  bellows-fashion,  force  the  water  through  every  inter- 
stice of  the  teeth  and  appliance  to  flush  out  accumulations. 
This  should  be  done  each  time  after  eating  as  well  as  before 
retiring  and  after  rising. 

Most  appliances  can  be  worn  a  long  time  without  injury 
to  tooth  substance,  if  they  are  properly  constructed  and  kept 
scrupulously  clean. 

Without  cleanliness,  the  teeth  will  soon  be  injured  by  the 
secretions  and  accumulations,  and  the  breath  of  the  patient, 
from  the  same  cause,  will  become  so  offensive  as  to  disgust 
all  brought  within  its  range. 

Inconspicuousness. — Annoyance  from  wearing  a  conspicu- 
ous appliance  is  often  added  to  the  other  ills  which  the 
patient  is  subjected  to  during  the  process  of  regulation.  An 
appliance  of  this  character,  while  often  producing  distortion 
of  the  lips,  also  attracts  much  attention  and  compels  the 
wearer  to  make  frequent  answers  to  the  same  oft-repeated 
question. 

Young  persons  attending  school  or  entering  society  are 


84  ORTHODONTIA. 

naturally  very  sensitive  to  the  ill-appearance  of  any  con- 
sj)icuous  device.  Whenever  the  same  result  can  be  accom- 
plished by  a  concealed  fixture  as  by  an  exposed  one,  it  is 
better  to  adopt  the  former;  but  where  a  better  or  more 
satisfactory  result  can  be  obtained  by  the  use  of  a  more 
prominent  fixture,  appearance  will,  of  course,  have  to  be 
subordinated  to  utility. 

Stability. — The  quality  of  stability  has  previously  been 
spoken  of,  but  its  real  practical  importance  cannot  be  too 
strongly  insisted  upon.  It  is  a  sine  qua  non  in  orthodontic 
practice.  With  it,  we  have  a  reasonable  certainty  of  results  ; 
without  it,  all  is  uncertainty. 

In  some  cases,  as  where  most  or  all  of  the  superior  teeth 
are  to  be  drawn  backward,  we  have  apparently  no  point  for 
proper  anchorage.  Stability  or  fixedness  of  position  for  an 
appliance,  in  such  cases,  not  being  obtainable  wuthin  the 
mouth,  some  fixture  can  be  devised  which  will  have  its  point 
of  resistance  outside,  as  on  the  back  of  the  head. 

This  plan  of  securing  resistance  outside  of  the  mouth, 
has  been  adopted  thus  far  only  in  a  few  exceptional  cases, 
but  it  is  hoped  that  its  advantage  and  importance  will  lead 
to  its  more  frequent  employment  in  the  future. 

Freedom  from  injury  to  tooth  substance. — By  this  we  do  not 
mean  chemical  injury,  for  that  has  already  been  treated  of, 
but  we  refer  to  mechanical  injur3^  Any  sharp,  hard  point 
or  roughness  of  a  metallic  appliance,  will  be  likely  to  scratch 
and  mar  the  surface  of  enamel  and  thus  prepare  the  way  for 
future  decay. 

Steel  jack-screws  of  any  form,  when  j^laced  directly  against 
the  teeth  of  anchorage  and  those  to  be  moved,  are  liable  to 
work  injury  to  tooth  structure.  For  this  reason  there  should 
always  be  interposed  between  the  teeth  and  screw  some 
material  that  is  non-injurious  to  the  tooth.  Besides  protect- 
ing the  teeth,  such  substance  will  also  serve  to  give  greater 
security  to  the  screw. 

To  obtain  this  same  fixedness  for  the  point  of  a  fish-tail 
jack-screw,  or  other  appliance,  some  operators  have  been 


MATERIALS    AND    METHODS.  85 

in  the  habit  of  drilling  a  hole  or  depression  in  the  tooth  to 
be  moved.  It  is  hoped  that  the  introduction  of  the  Magill 
band  has  caused  the  abandonment  of  this  practice,  which  at 
best  was  only  justifiable  in  exceptional  cases  and  in  self- 
cleansing  localities. 

RETAINING  APPLIANCES. 

The  retention  in  situ  of  teeth  that  have  been  moved,  for  a 
time  sufficiently  long  to  allow  them  to  become  firm,  is  quite 
as  important  as  the  moving  of  them.  As  previously  explained, 
teeth  become  firm  in  their  new  position  by  virtue  of  a  deposit 
of  ossific  matter  in  the  space  created  by  their  displacement. 
The  formation  and  perfect  ossification  of  this  new  material 
is  only  completed  after  a  lapse  of  time  varying  with  the  age 
and  constitution  of  the  individual.  Experience  has  proven 
that  a  less  time  than  six  months  should  never  be  allowed 
for  it,  while  in  persons  of  mature  age  or  in  those  younger 
where  many  teeth  have  been  involved,  the  time  will  some- 
times have  to  be  extended  to  a  year  or  longer. 

The  natural  tendency  of  a  tooth  to  return  to  its  former 
position,  aided  by  the  tension  of  the  parts  that  have  resisted 
its  movement,  will  certainly  move  a  tooth  from  its  new 
position,  unless  the  newly  formed  process  has  become  thor- 
oughly calcified,  and  is  thus  by  its  strength  and  density 
able  to  resist  the  opposing  forces.  Numberless  failures  to 
retain  the  good  results  of  regulation  are  attributable  to  this 
cause  alone. 

In  certain  cases,  as  where  a  superior  incisor  has  been 
occluding  inside  of  the  lower  ones,  or  where  a  lower  one  has 
been  biting  outside  of  the  upper  ones,  no  retaining  appliance , 
will  be  required  after  they  have  been  brought  into  proper 
position,  because  the  natural  occlusion  of  the  jaws  will  pre- 
vent the  corrected  tooth  from  returning  to  its  former  jDosi- 
tion. 

So  also  with  the  bicuspids  and  molars.  Where  mal- 
occlusion has  forced  them  out  of  their  true  position,  or  kept 


86 


ORTHODONTIA. 


them  there,  the  correction  of  the  occlusion  will  often  tend  to 
retain  them  in  their  normal  positions  without  extraneous  aid. 
In  all  other  cases,  however,  mechanical  assistance  will  be 
necessary  until  the  teeth  have  become  firm.  Where  the  arch 
or  any  portion  of  it  has  been  enlarged,  or  where  a  number 
of  teeth  have  been  moved  from  within  outward,  the  simplest 
and  probably  the  best  means  of  retaining  them  will  be  the 
wearing  of  a  thin  rubber  or  metal  plate  covering  the  palatal 
arch  and  nicely  fitting  each  tooth  at  its  neck.  It  may  contain 
a  vacuum-chamber  or  not,  as  preferred,  but  in  many  cases 
the  use  of  one  will  greatly  assist  in  keeping  the  plate  in  place. 
In  addition  to  its  use  in  preventing  teeth  from  moving 
inward,  the  plate  may  often  be  advantageously  modified  by 
the  addition  of  a  gold  hook  or  spur  to  keep  rotated  teeth  in 
position,  or  to  retain  individual  teeth  that  have  been  moved 
inward. 

While  rubber  plates  in  some  form,  either  by  themselves  or 
in  combination  with  accessories,  are  frequently  used  for  retain- 
ing corrected  teeth,  their  use  is,  nevertheless,  open  to  certain 
objections.  All  rubber  plates  used  either  for  correction  or 
retention,  must  be  removed  at  frequent  intervals  for  cleans- 
ing. The  very  necessity  for  their  removal  affords  opportunity 
for  the  patient  to  remove  them  at  other  times,  and  possibly 
forget  or  willfully  neglect  to  reinsert  them  for  a  longer  or 

shorter  period,  thus 
causing  delay  in  the 
reparative  process. 

Besides  this,  also, 
in  the  very  act  of  re- 
moval and  insertion 
the  teeth  are  slightly 
moved  in  their  sock- 
ets, and  this  will  to  a 
certain  degree  hinder 
the   re-formation   of 

The  Author's  Band  and  Bar  Retainer.  tisSUe 


Fig.  17. 


MATERIALS    AND    ^rETHODS. 


87 


Fig.  18. 


On  account  of  these  objectionable  features  the  author  has 
for  many  years  avoided  the  use  of  rubber  retaining  plates, 
wherever  he  could  do  without  them.  As  a  substitute  he 
was  led  to  devise  a  number  of  little  appliances  of  gold  and 
platinum,  occupying  the  least  possible  space,  and  firmly 
attached  to  the  teeth  for  the  required  time.  Fig.  17  shows 
one  of  these  appliances  in  its  simplest  form.  It  consi.sts  of  a 
"platinum  (Magi II)  band,  freely  fitted  to  the  tooth,  and  having 
a  gold  bar  or  spur  soldered  to  it  to  press  or  bear  against  one 
or  more  of  the  adjoining  teeth.  When  properly  adjusted,  it 
is  secured  to  the  corrected  tooth  by  means  of  phosphate  of 
zinc. 

As  will  readily  be  seen,  its  advantages  consist  in  its  small 
size,  its  slight  contact  with  teeth  other  than  the  one  upon 
which  it  is  placed,  its  cleanliness,  its  fixedness  and  the 
firmness  with  which  it  holds  the  corrected  tooth  in  place. 

The  latter  is  its  most  important  feature, 
for  it  is  a  well  recognized  fact  in  surgical 
practice  that,  other  things  being  equal,  re- 
uTiion  of  bony  tissue  or  new  formation  of 
the  same  will  progress  in  rapidity  propor- 
tionate to  the  stability  of  the  parts. 

Fig.  18  shows  a  modification  where  two 
teeth  are  thus  to  be  retained  with  the  exten- 
sion bar  long  enough  to  include  more  dis- 
tant teeth.     Fig.  19   represents   two   bands 
Fig.  20.  joined  at  their  borders,  for 

the  retention  of  two  teeth 
that  have  been  rotated. 

Still  another  modifica- 
tion is  shown  in  Fig.  20. 
In  this  case  the  two  bands 
on  the  cuspids  are  united 
by  a  thin  gold  or  platinum 
wire  passing  along  and  con- 
forming in  outline  to  the 
labial  surfaces  of  the  inter- 


Retainer. 


Fig.  19. 
Retainer. 


Band  and  Wire  Retainer. 


88 


ORTHODONTIA. 


Fig.  22. 


vening  teeth.     It  was  used  to  retain  three  incisor  teeth  that 
had  been  drawn  inward. 

Fig.  21  ilhistrates  a  retainer  of  nearly  similar  character 
for  the  lower  incisors.  In  this  case  a  band  of  gold  takes  the 
place  of  the  wire  on  account  of  its  greater  stiffness. 

Retaining  appliances  of  this  character  cannot,  of  course, 
Fig.  21.  t)e  used  to  advantage  in  all 

/^  ~  .«^=fe_.        cases ;    but  where   they  carf 

they  will  be  found  to  be  most 
satisfactory. 
Mir  T^^^it"  ^lIL/r '  Prof.  Angle  uses  a  retain- 

ing appliance  differing  from 
the    foregoing   in   having  a 
tube    soldered    horizontally 
to  the  band  that  encircles  the   tooth.     The  tooth  once  in 
position  a  wire  is  passed  tli rough  the  tube  and  made  to  rest 
upon  the  adjoining  teeth,  after  which 
a  hole  is  drilled  through  both  tube  and 
wire  and  a  short  pin  inserted  to  prevent 
the    wire    from    shifting    its    position. 
See  Fig.  22. 

Another  simple  and  ingenious  device 
for  retaining  teeth 
alter  they  have 
been  moved,  espe- 
cially after  rota- 
tion, was  shown 
the  author  by  Dr. 
H.  A.  Baker.  It 
consists  of  a  gold 
screw  cemented 
into  some  conven- 
ientl}^  located  cav- 
ity in  such  a  way 
that  the  protrud- 
ing portion  will 
rest  against  an  adjoining  tooth,  and  thus  prevent  the  tooth 


Angle's  Ketainer. 


Baker  s  Retainer 


MATERIALS    AND    METHODS. 


89 


Fig.  24. 


operated  upon  from  changing  its  new  position.  Such  device 
could,  of  course,  only  be  used  in  rare  and  exceptional  cases; 
but  where  applicable,  it  possesses  the  advantages  of  sim- 
plicity, inconspicuousness  and  efficiency.  Fig.  23  represents 
a  case  in  which  a  rotated  incisor  was  thus  retained. 

A  very  simple  appliance  for  holding  teeth  that  have  been 
drawn  toward  one  another  is  shown  in  Fig.  24,  and  was 
devised  and  first  used  by  Dr.  G.  S.  Case. 
It  consists  of  a  silver  or  platinum  wire 
passed  over  lugs  or  pins  upon  bands  at- 
tached to  the  teeth  to  be  retained.     Floss 
silk  or  China-grass  line,  used  in  the  same 
manner  would   answer   instead  of  wire ; 
but  they  would  neither  be  as  strong  nor 
as  cleanly.     Dr.  Case  also  uses  the  wire 
for  exerting  a  gentle  traction  force  where 
needed   by   soldering   a  piece  of   square 
metal   tubing  to  it  at  about  the  middle 
of  its  length  and  turning  this  with  a  suitable  instrument, 
thus  twisting  the  wires  and  drawing  the  teeth  together. 


CHAPTER  III. 
CONSIDERATION  OF  METHODS. 

faerar's  method. 

In  1876  Dr.  J.  N.  Farrar  began  publishing  a  series  of 
articles  in  the  Dental  Cosmos,  descriptive  of  a  method  he  had 
devised  for  the  regulation  of  teeth.  Reading  and  observa- 
tion, he  said,  had  satisfied  him  that  the  various  plans  sug- 
gested up  to  that  time  for  the  correction  of  irregularity,  were 
lacking  both  in  system  and  principle.  He  claimed  that  the 
performance  of  so  important  an  operation  as  regulation 
should  be  based  upon  a  correct  knowledge  of  both  mechani- 
cal and  physiological  law. 

Experience  had  convinced  him  that  the  character  of  force 
applied  to  the  teeth  should  be  positive,  and  that  it  should  be 
intermittent — a  period  of  rest  following  a  period  of  motion. 

The  best  instrument  for  applying  a  force  that  is  positive 
and  may  be  intermittent,  he  said,  was  the  screw  in  one  of  its 
various  forms. 

Experimenting  with  appliances  constructed  upon  the  screw 
principle,  convinced  him  that  this  method  of  delivering  force 
was  not  only  positive  and  direct,  but  also  that  its  range  of 
applicability  was  so  great  that  it  might  be  used  to  the  best 
advantage  in  nearly  all  cases  of  regulating.  He  claimed, 
also,  that  it  was  the  only  instrument  whose  force  could  be 
controlled  at  will  and  thus  be  made  to  exert  power  upon  or 
retain  in  a  state  of  repose  the  tooth  or  teeth  operated  upon. 

This  alternation  of  motion  and  rest  was  as  important  in 
changing  the  jDosition  of  teeth  as  in  other  organs  of  the 
body,  and  was  in  strict  accord  with  physiological  law.  In 
his  experiments  he  found  that  intermittent  force  was  pro- 

90 


MATERIALS    AND    METHODS.  91 

ductive  of  less  pain  to  the  patient  than  continuous  force,  and 
might  be  so  skilfully  applied  as  to  prevent  all  pain. 

Pain,  he  said,  was  an  expression  of  a  pathological  condi- 
tion, and  by  its  avoidance  we  kept  within  the  boundary 
separating  the  physiological  from  the  pathological  state. 
With  screws  of  known  pitch  and  number  of  threads,  he 
found  that  he  could  move  a  tooth  painlessl}^  and  therefore 
safely,  from  a-fu  to  rsir  of  an  inch  every  twenty-four  hours. 
His  experiments  led  him  to  the  following  conclusions : — * 

"  1st.  That  in  regulating  teeth,  the  traction  must  be  inter- 
mittent, and  must  not  exceed  certain  fixed  limits. 

"M  That  while  the  system  of  moving  teeth  by  elastic 
rubber  apparatus  is  unscientific,  leads  to  pain  and  inflamma- 
tion, and  is  dangerous  to  the  future  usefulness  of  the  teeth 
operated  upon,  a  properly  constructed  metallic  apparatus, 
operated  by  screws  and  nuts,  produces  happy  results,  without 
pain  or  nervous  exhaustion. 

"  Sd.  That  if  teeth  are  moved  through  the  gums  and 
alveolar  process  about  2T7  of  an  inch  every  morning,  and 
the  same  in  the  evening,  no  pain  or  nervous  exhaustion 
follows. 

"  4-th.  That  while  these  tissues  will  allow  an  advancement 
of  a  tooth  at  this  rate  (aTjr  of  an  inch),  twice  in  twenty-four 
hours,  the  changes  being  physiological,  yet,  if  a  much 
greater  pressure  be  made,  the  tissue  changes  will  become 
pathological." 

The  above  conclusions  were  epitomized  by  him  into  the 
following  Law: — "In  regulating  teeth,  the  dividing  line 
between  the  production  of  physiological  and  pathological 
changes  in  the  tissues  of  the  jaw  is  found  to  lie  within  a 
movement  of  the  teeth  acted  uj)on,  allowing  a  variation  which 
will  cover  all  cases,  not  exceeding  gio  or  y^o  of  an  inch  every 
twelve  hours." 

*  Dental  Cosmos,  Vol.  XVIII,  p.  23. 


92  ORTHODONTIA. 

His  articles  upon  the  subject  may  be  found  in  the  Dental 
Cosmos,  extending  from  Vol.  XVIII  to  XXIV. 

Although  the  screw  principle  was  the  one  which  he  prin- 
cipally used,  and  the  only  one  which  he  considered  scientifi- 
cally and  physiologically  correct,  he  at  times  availed  himself 
of  the  use  of  some  of  the  continuous-force  appliances,  such 
as  rubber  bands,*  silk  or  fibre  ligatures,t  and,  for  the  attach- 
ment of  appliances,  vulcanite  plates.^ 

So  far  as  the  principles  upon  which  Dr.  Farrar's  system  is 
based  are  concerned,  they  have  received  but  limited  endorse- 
ment on  the  part  of  the  profession,  but  the  multiplicity 
and  variety  of  his  appliances  and  the  ingenuity  displayed 
in  their  devising,  have  commanded  the  admiration  of  all 
and  been  of  great  value  to  laborers  in  this  field.  Most  of  his 
appliances  are  original  in  design,  beautiful  in  construction, 
and  well  calculated  to  perform  the  work  intended  ;  but  in 
confining  himself  so  largely  to  the  use  of  one  form  of  power- 
producing  instrument,  his  apparatus  is  in  many  cases  very 
elaborate  and  complicated.  The  same  end  could  often  be 
accomplished  by  much  simpler  means. 

His  appliances  are  so  numerous  that  illustrations  of  many 
of  them  could  not  be  introduced  into  a  text  book,  nor  could 
they  well  be  selected  from  to  illustrate  his  principles,  but 
some  of  them  may  be  found  in  Part  III,  where  the  practical 
treatment  of  various  forms  of  irregularity  is  considered. 

Dr.  Farrar  has  recently  published  in  book  form  a  full 
elaboration  of  his  views  and  methods,  together  with  numer- 
ous illustrations  of  his  appliances,  to  which  the  reader  is 
referred. 

Patrick's  method. 

In  1882,  Dr.  Patrick  brought  forward  his  method  of  regu- 
lating.    His  appliance  is  made  of  gold,  and  designed  to  be 

*  Cosmos,  Vol.  XIX,  p.  520. 
t       "  "    XXI,   "  306. 

:|:       "  "    XXI,   "  306. 


MATERIALS   AND    METHODS. 


93 


Fig.  25. 


attached  directly  to  the  teeth  on  presentation  of  patient, 
without  the  usual  preliminaries  of  taking  an  impression  and 
making  a  model. 

The  appliance  with  its  appurtenances,  all  heautifully  con- 
structed and  ready  for  use,  may  be  purchased  from  the 
inventor  or  through  the  dental  depots. 

The  essential  parts  consist  of  a  bow-spring,  adjustable 
anchor  bands,  and  numerous  devices  for  engaging  with  the 

teeth  to  be  moved. 
Fig.  25  represents 
the  apjDliance  with 
many  of  the  acces- 
sories in  position. 
The  bow-spring 
"A"  consists  of  a 
half-round  bar  or 
wire  of  platinized 
gold,  bent  in  horse- 

Patrick's  Regulating  Appliance.  sllOC    fomi     to     ap- 

proximately conform  to  the  shape  of  the  arch.  "  BB  "  are 
the  adjustable  loop-bands,  made  of  thin  gold  plate,  the  free 
ends  of  which,  on  their  palatine  surfaces,  are  connected  with 
a  screw  and  fixed  nut  (C),  for  bringing  the  band  in  close 
contact  with  the  tooth  to  which  it  is  applied.  On  the  buccal 
surfaces  of  these  bands  are  soldered  sections  of  half-round 
tubing,  accurately  fitting  the  bow-spring  which  plays  through 
them.  Outside  of  this  tubing  is  soldered  a  nut  threaded  to 
receive  the  long  buccal  screw  (D)  intended  to  tighten  the  bow- 
spring  after  it  is  in  position,  or  to  take  up  the  slack  caused 
by  the  moving  teeth.  The  head  of  this  screw  passes  through 
and  operates  against  a  smooth  nut  soldered  to  a  section  of  the 
tubing  which  is  temporarily  attached  to  the  bow-spring  at 
any  point  by  means  of  an  adjustable  double  wedge. 

Of  the  accessory  appliances  shown,  "  E  "  is  a  hook  intended 
to  rest  against  the  mesial  or  distal  (by  reversing)  surfaces  of 
a  tooth  intended  to  be  moved  in  an  anterior  or  posterior 


94  ORTHODONTIA. 

direction.  It  is  secured  in  the  desired  position  by  a  wedge 
placed  between  the  inner  flat  surface  of  the  spring  and  the 
adjoining  surface  of  the  slide  to  which  the  hook  is  attached. 
The  tooth  is  moved  anteriorly  or  posteriorly  by  loosening 
the  buccal  screw  on  one  side  and  tightening  it  on  the  other 
toward  which  the  tooth  is  intended  to  be  moved.  "  F  "  is  a 
hook  to  catch  over  the  cutting  edges  of  incisors  when  it  is 
desired  to  move  them  from  within  outward.  When  in  posi- 
tion the  tension  of  the  bow-spring  is  increased  from  time-  to 
time  by  unscrewing  the  buccal  screws.  "  H  "  is  a  slide  or 
section  of  the  half-round  tubing,  reinforced  on  its  palatine 
surface  by  additional  gold,  and  intended  to  be  used  as  a  stud 
to  prevent  one  portion  of  the  tooth  from  moving  while  the 
opposite  one  is  being  moved,  as  in  rotating  an  incisor.  It  is 
also  used  to  press  against  any  tooth  as  a  wedge  in  moving 
it  inward. 

"  G  "  is  a  T-bar  for  producing  double  rotation  of  the  inci- 
sors. "  I  "  is  a  hook  set  vertically  to  engage  with  the  cutting 
edge  of  an  incisor,  to  prevent  the  bow-spring  from  slipping 
up  toward  the  gum. 

"  J  "  is  a  bifurcated  hook,  to  grasp  a  cuspid  tooth  intended 
to  be  moved  outward. 

Each  of  these  appurtenances  is  soldered  to  a  section  of  the 
half-round  tubing,  which  allows  it  to  be  moved  to  any  desired 
position  on  the  bow-spring.  When  in  position  it  is  retained 
by  means  of  the  wedge  already  referred  to. 

As  will  readily  be  seen,  the  power  obtained  by  this  apj)li- 
ance  consists  partly  in  the  elasticity  of  the  bow-spring  and 
partly  in  the  direct  action  of  the  tightening  screws. 

The  ingenuity  displayed  in  the  devising  of  this  method  is 
certainly  very  great,  and  the  delicacy  and  accuracy  of  con- 
struction of  the  various  parts  all  that  could  be  desired.  The 
combination  of  the  principles  of  the  spring  and  screw  bring 
into  play  two  of  the  most  important  powers  available  in 
regulation,  and  their  correlation  in  this  method  is  very 
happily  brought  about. 


MATERIALS    AND    METHODS.  95 


BYRNES     METHOD. 


Dr.  B.  8.  Byrnes  has  devised  a  method  for  regulating  teeth 
by  the  use  of  narrow  strips  of  fine  gold  variously  shaped  and 
bent  to  produce  tension  upon  the  malposed  teeth.  The 
method  is  an  exceedingly  novel  and  ingenious  one,  and  while 
it  could  not  be  used  to  advantage  in  all  cases,  still  contains 
elements  of  merit  that  will  be  of  value  to  the  practitioner. 
His  j)0wer  is  derived  from  the  elasticity  of  the  metal,  which 
is  corrugated  in  such  a  manner  as  to  develop  this  quality  to 
the  highest  degree. 

His  bands  are  made  from  gold  jjlate  of  20  to  22  k.  fine- 
ness, rolled  very  thin,  and  when  greater  power  is  needed  the 
bands  are  doubled  in  thickness.  He  uses  no  plates,  but 
anchors  his  appliances  by  means  of  bands  to  suitable  teeth,, 
situated  at  some  distance  from  the  ones  to  be  moved. 

*  The  method  of  application,  in  a  general  way,  is  as  fol- 
lows : — The  fixed  points  having  been  determined  upon,  the 
tooth  or  teeth  to  be  regulated  are  connected  with  them  by 
means  of  a  thin  gold  band.  The  band  is  manipulated 
so  as  to  form  it  into  a  spring,  or  series  of  springs,  so  adjusted 
as  to  bear  most  powerfully  on  the  misplaced  tooth.  Thus, 
supposing  that  a  projecting  superior  central  incisor  is  to  be 
drawn  inward  to  align  properly  with  the  remainder  of  the 
teeth  in  the  arch,  a  continuous  gold  band  embracing  the 
first  molars  on  both  sides  is  fitted  around  the  outside  of  the 
arch. 

With  a  dull-pointed  instrument,  like  a  burnisher,  the 
ribbon  is  then  pressed  into  the  interstices  of  the  teeth 
over  which  it  passes,  thus  forming  it  into  a  series  of  small 
springs.  The  incisor  being  the  most  prominent  point  will 
naturally  \)e  most  affected  by  the  pressure  exerted  by  the 
springs,  and  in  a  short  time  it  will  be  found  to  have  moved 
away  from  the  band,  so  that  it  is  no  longer  affected  by  its 
tension.  As  soon  as  this  occurs  the  apparatus  is  removed, 
the  ribbon  annealed  and  straightened,  and  a  small  portion^ 

*  Dental  Cosmos,  Vol.  XXVIII,  pp.  278-284. 


96 


ORTHODONTIA. 


Fig.  26. 


say  a  thirty-second  to  a  sixteenth  of  an  inch,  as  may  be 
required,  is  cut  out  of  it.  The  ends  are  then  soldered  and 
the  appliance  replaced  upon  the  teeth,  the  connecting  band 
being  formed  into  a  spring  as  before.  Tension  is  thus  kept 
up  until  the  tooth  has  assumed  the  desired  position.  Some- 
times the  spring  of  the  band  may  be  advantageously  supple- 
mented by  other  aids,  as 
the  insertion  of  a  rubber 
wedge  (under  the  band)  at 
points  where  a  particular 
gain  is  desired. 

Figs.  26,  27  and  28  illus- 
trate the  general  appear- 
ance of  the  appliance  in 
some  of  its  forms. 

Figs.  26  and  27  were 
used  to  draw  in  projecting 
incisors  in  the  case  of  a 
young  lady,  aged  18.  The 
movement  was  assisted  by 
rubber  wedges  placed  be- 
tween the  band  and  the 
labial  surfaces  of  the  teeth. 
"  The  connecting  band  was 
cut  and  shortened  every 
other  day,  the  patient  hav- 
ing a  sitting  every  day  to 
allow  the  band  to  be 
sprung  more  as  the  teeth 
moved  away  from  it." 

Fig.  28  represents  the  form  of  appliance  used  by  Dr. 
Byrnes  in  drawing  forward  the  lower  incisors,  and  pressing 
back  the  cuspids  at  the  same  time.  The  band  clasped  the 
first  molars  of  each  side  and  passed  around  the  cuspids  and 
back  of  the  incisors.     By  cutting  and  shortening  the  band 


Byrnes'  Band  Regulators. 


MATERIALS    AND    METHODS. 


97 


from  time  to  time  as  the  teeth  yielded  to  the  pressure,  the 
irregularity  was  easily  and  quickly  corrected. 

YiG.  29.  Fig-    29   shows  another 

form  of   corrugated  band 
used  to  press  forward  the 
Fig.  30. 


Corrugated  Band  Regulator  (Byrnes).  Band  Regulators. 

inferior  incisors.     Two  teeth  on  each  side  are  here  used  as 
anchorages,  being  connected  by  a  single  continuous  band. 

Fig.  30  illustrates  other  forms  of  the  band  regulator  made 
from  extremely  narrow  strips  of  gold. 

THE    MAGILL    BAND. 

This  device,  while  not  properly  constituting  a  method,  is 
considered  here,  because  through  its  great  value  it  has  come 
to  be  an  important  factor  in  several  methods  of  regulating 
devised  since  its  introduction.  Dr.  W.  E.  Magill,  having  in 
common  with  other  practitioners  experienced  the  difficulty 
of  attaching  regulating  appliances  to  the  natural  teeth  in 
such  a  way  that  they  would  have  a  firm  hold  and  not  slip, 
devised  the  following  plan  of  meeting  and  overcoming  the 
difficulty : — 

From  a  piece  of  platinum,  German  silver  or  platinized 
silver  plate.  No.  28,  (B.  and  S.)  gauge  in  thickness,  he  cut  a  strip 
about  a  line  in  width  and  bending  it  to  conform  to  the 
shape  of  the  tooth  soldered  it  at  the  point  where  the  ends 
overlapped,  thus  converting  it  into  a  band  or  ferrule. 
After  attaching  to  this  band  any  studs,  pins  or  hooks  that 
the  case  demanded,  it  was  lined  with  oxy-chloride  of  zinc  and 


98  ORTHODONTIA. 

slipped  over  the  dried  tooth  to  a  point  about  midway  be- 
tween the  cutting  edge  and  neck. 

Since  the  introduction  of  phosphate  of  zinc,  it  has  been 
found  to  be  a  far  better  medium  for  the  attachment  of  the 
band  to  the  tooth  than  the  oxy-chloride  of  zinc,  formerly 
used.  Once  in  position,  the  cement  will  harden  in  about 
five  minutes,  after  which  no  ordinary  force  will  be  able  to 
dislodge  it.  If  a  wire  spring  is  intended  to  rest  against  and 
press  upon  a  banded  tooth,  a  hole  or  pit  should  be  drilled  in 
the  band  at  a  suitable  point,  before  it  is  cemented  in  place. 
If  rubber  bands  or  ligatures  are  to  be  employed,  suitable 
provision  for  their  easy  attachment  may  be  made  by  pre- 
viously soldering  to  the  band  a  small  gold  hook,  or  a  headed 
platinum  pin  taken  from  a  vulcanite  tooth.  Where  a  jack- 
screw  is  to  be  used  in  the  moving  of  a  tooth,  an  abutment 
of  platinum  should  be  soldered  to  the  band  encircling  the 
resisting  tooth,  and  then  be  slotted  to  receive  one  end  of  the 
screw.  The  band  of  the  tooth  to  be  moved  should  also 
be  reenforced  and  drilled  to  accommodate  the  point  of  the 
screw. 

When  the  operation  is  completed,  or  when  for  any  cause  it 
may  be  desired  to  remove  the  band,  it  is  easily  accomplished 
by  protecting  the  enamel  at  the  cutting  edge  of  the  tooth 
with  a  folded  napkin  or  piece  of  chamois  skin,  and  placing 
one  beak  of  a  pair  of  pliers  upon  it  and  the  other  upon  tlie 
upper  edge  of  the  band,  the  closure  of  the  hand  will  dis- 
lodge the  appliance  without  in  the  least  marring  or  altering 
its  form.  By  this  simple  invention,  one  of  the  greatest  diffi- 
culties hitherto  experienced  in  regulating  has  been  overcome, 
and  its  devising  has  almost  introduced  a  new  era  in  regu- 
lating. For  the  purpose  intended,  there  is  nothing  that 
approaches  it  in  efficiency. 

Before  its  introduction,  attachment  to  the  tooth  to  be 
moved  was  usually  effected  by  means  of  a  ligature  ingeni- 
ously applied  and  made  fast  by  some  form  of  knot,  or  a  pit 
or  hole  was  drilled  into  the  substance  of  the  tooth  to  receive 


MATERIALS    AND    METHODS.  99 

the  point  of  a  screw  or  other  device  and  prevent  it  from 
slipping.  The  knots  would  often  slip,  and  the  drilling  of 
pits  was  objectionable,  so  that  the  difficulties  of  securement 
were  not  overcome  until  the  invention  of  this  band. 

By  its  use  absolutely  secure  attachment  and  anchorage  are 
obtained,  and  the  moving  of  teeth  is  accomplished  with  far 
greater  exactness  than  had  previously  been  possible.  When 
attachment  was  made  by  ligature,  it  was  often  necessary 
that  the  ligature  should  encircle  the  tooth  at  its  neck,  and 
when  not  necessary  to  place  it  there  it  would  often  slip  into 
that  position  owing  to  the  shape  of  the  tooth.  The  irrita- 
tion of  the  soft  tissues  thus  produced  was  frequently  the 
cause  of  much  pain  to  the  patient.  The  Magill  band  oljviates 
this  by  preventing  any  fixtures  attached  to  it  from  coming 
in. contact  with  the  delicate  and  sensitive  mucous  membrane 
of  the  gum. 

Indeed,  the  author  has  found  that  by  its  use  nearly  all  the 
pain  of  regulating  has  been  done  away  with,  for  the  pain 
attendant  upon  regulating  by  the  old  methods  was  caused 
not  so  much  by.  the  slight  irritation  induced  by  the  moving 
tooth,  as  by  the  impingement  of  ligatures,  rubber  bands  and 
other  appliances  upon  the  soft  tissues.  The  Magill  band  may 
therefore,  we  think,  be  credited  with  having  done  more  to 
modify  the  pain  accompanying  regulation  than  any  other 
device  ever  introduced. 

In  some  methods  of  regulating,  such  as  Farrar's  and  Pat- 
rick's, attachment  is  made  to  the  teeth  by  means  of  an  open 
band  of  gold  secured  to  the  teeth  by  a  nut  and  bolt  operat- 
ing upon  the  free  ends  of  the  band.  Such  device,  while 
valuable,  is  more  complicated,  cumbersome  and  less  cleanly 
than  the  Magill  band.  It  is  also  open  to  the  objection  pre- 
viously noted,  that  of  allowing  the  secretions  to  remain 
between  the  tooth  and  band. 

Several  of  the  author's  methods  of  modifying  the  form  of 
the  band  by  means  of  attachments  to  increase  its  usefulness, 
are  illustrated  in  Part  III. 


100  orthodontia. 

angle's  method. 

This  method  of  regulating  was  first  brought  to  the  notice 
of  the  profession  by  its  originator,  Prof.  Edward  H.  Angle, 
in  a  paper  read  before  the  dental  section  of  the  Ninth  Inter- 
national Medical  Congress,  held  in  Washington,  D.  C,  Sep- 
tember, 1887. 

The  appliances  used  in  this  method  are  mostlj''  made  from 
German  silver,  although  the  levers  are  of  steel  and  the 
retaining  wire  of  gold.  German  silver  is  strong,  easily 
adapted  and  inexpensive,  while  the  steel  piano-wire  com- 
bines strength  and  elasticity  with  lightness  and  delicacy. 

Power  is  obtained  by  the  well-known  mechanical  prin- 
ciples of  the  screw  and  lever,  while  support  or  resistance  is 
gained  b}^  firmly  attaching  the  parts  to  the  teeth  by  the 
Magill  band,  which  is  cemented  in  place,  or  by  an  adjustable 
clamp  band. 

The  appliances  are  few  in  number,  simple  in  design,  and 
easily  applied ;  qualities  that  add  materially  to  the  value  of 
any  device  for  general  use.  Prof.  Angle,  in  describing  his 
method,  says  : — 

''  Fig.  31  shows  the  simple  appliances  from  which  all  the 
various  combinations  used  in  the  original  method  may  be 
made.  "  A  "  is  a  large  traction  screw  encased  in  its  accom- 
j)anying  tube,  and  used  for  pulling  where  the  resistance  is 
great.  "  B  "  is  a  smaller  traction  screw,  used  in  the  same 
way  where  the  resistance  is  slight,  or  where  from  any  reason 
a  delicate  appliance  is  desired.  "  C  "  and  "  D  "  are  tubes 
which  are  soldered  to  bands  placed  upon  the  teeth  to  be 
moved,  into  which  the  ends  of  the  traction  screws  are 
hooked.  "  J"  is  a  jack-screw,  used  for  pushing,  the  end  of 
which  is  beaten  flat.  "  E  "  is  an  extra  piece  of  tubing,  by 
means  of  which  a  longer  jack-screw  can  be  made.  "F"  and 
"  H  "  are  coils  of  band  material  of  different  thicknesses.  "  G  " 
is  a  gold  wire  used  in  retaining  the  teeth  and  also  to  assist 


MATERIALS    AND    METHODS. 


101 


in  securing  anchorage  in  some  cases,  and  "  RR  "  are  small 
retaining  tubes,  into  which  the  retaining  wire  accurately  fits, 

Fig.  31. 


Angle's  Appliances. 

and  are  designed  to  be  soldered  to  bands.  "  LL  "  are  piano- 
wire  levers  of  varying  sizes,  giving  different  degrees  of 
power. 

"  Aside  from  the  advantages  of  simiDlicity,  efficiency  and 
cleanliness,  which  are  insured  by  these  ai3j)liances,  a  still 
greater  desideratum  is  gained  by  means  of  the  mechanical 
principles  observed  in  their  construction.  Stationary  an- 
chorage and  non-relinquishment  of  pressure  are  prominent 
features  of  this  method,  and  are  certainly  secured  almost  to 
perfection, 

"  The  means  by  which  one  or  more  teeth  are  held  perfectly 
stationary,  while  serving  as  an 
anchorage  or  base  of,  resistance  for 
the  application  of  force  is  quite 
simple  and  peculiar  to  this  method. 
"  One  or  more  teeth  are  banded, 
as  shown  in  Fig.  32.  Soldered  to 
the  bands  is  a  tube  of  some  length. 

stationary  Anchorage.  (Angle)         rni  i       ji   •       ,     i  ••-,■,„ 

Through   this  tube   a   rigid   shaft, 
threaded  at  one  end  and  bent  to  a  right  angle  at  the  other,  is 


Fig.  32. 


102 


ORTHODONTIA. 


passed  to  a  tooth  to  be  moved.  On  turning  the  nut  the 
natural  tendency  would  be  to  tip  the  anchor  teeth  forward  in 
their  sockets ;  but  they  cannot  tip  thus,  because  of  their  rigid 
connection,  and  the  length  of  tube  surrounding  the  shaft. 
It  is  evident  that  two  teeth  thus  connected  cannot  move, 
except  as  they  move  together.  The  apices  of  the  roots 
must  move  the  same  distance  as  the  crowns,  if  any  move- 
ment at  all  occurs,  and  this  is  well  nigh  impossible.  The 
tooth  to  be  moved  is  connected  with  the  shaft  in  such  man- 
ner that  it  may  tip,  and  responds  by  moving  according  to 
the  force  applied.  The  dotted  lines  of  the  diagram  show 
the  direction  of  any  movement  that  occurs. 

"  A  few  of  the  principal  movements  are  selected  for  illus- 
tration from  the  many  modifications  of  which  the  appliances 
are  capable. 

"  The  application  and  operation  of  the  direct  screw  is 
shown  in  Fig.  33.  A  firm  anchorage  for  the  resistance  of 
the  screw  is  obtained  Fig.  33. 

by  banding  and  tub- 
ing the  left  cuspid, 
and  passing  through 
the  tube  a  piece  of 
gold  or  German  sil- 
ver wire  long  enough 
to  extend  to  and  rest 
against  adjoining 
teeth.  The  opposite  /|| 
cuspid  is  banded,  and 
a  retaining  tube  sol- 
dered   to    the    labial  Re-enforced  Anchorage.  (Angle.) 

surface.  The  lingual  surface  has  a  slot  cut  in  it  to  receive 
the  flat  end  of  the  jack-screw.  The  other  end  of  the  tube, 
in  which  the  screw  plays,  is  so  filed  that  it  rests  securely 
against  the  reenforcement  wire  and  the  tube  upon  the  lin- 
gual surface  of  the  cuspid  band.  After  being  brought  into 
position  the  tooth  is  held  in  place  by  j)assing  a  short  piece 


MATERIALS    AND    METHODS. 


103 


Fig.  34. 


Retraction  of  Cuspid.    (Angle. 


of  gold  wire  through  the  retaining  tube  on  the  labial  sur- 
face, which  is  left  in  place  until  the  tooth  is  firmly  set  in  its 
new  position. 

''  The  backward  movement  of    teeth  in  the  line  of    the 

arch  is  accomplished  by  the 
appliance  shown  in  Fig.  34. 
The  second  bicuspid  and 
first  molar  are  banded,  and 
the  tube  of  the  heavy  trac- 
tion screw  rigidly  soldered  to 
the  bands.  The  cuspid  to  be 
moved  is  banded,  and  a  short 
section  of  tubing  soldered  to 
it  to  receive  the  end  of  the 
traction  screw. 

On  turning  the  nut  trac- 
tion is  produced  and  the  cus- 
pid drawn  into  place.  The  cuspid  is  kept  from  being 
rotated  while  it  is  being  moved  backward,  by  means  of  the 
short  tube  accurately  fitting  the  right  angled  end  of  the 
traction  screw. 

"  Another  outward  movement  of  a  tooth  by  means  of  the 
jack-screw  is  shown  in 
Fig.  35.  The  second  bi- 
cuspid is  made  the  prin- 
cipal anchorage,  against 
which  the  base  of  the 
tube  rests.  The  band  en- 
circling the  lateral  incisor 
has  a  slot  cut  in  it  to 
receive  the  end  of  the  jack- 
screw.  The  anchorage  is 
reenforced  by  means  of  a 
wire  loop,  which  hooks 
into  tubes  upon  the  adjoining  central  and  cuspid,  and  is 
looped  over  a  spur  upon  the  body  of  the  jack-screw  tube. 


Fig.  35. 


Reciprocal  Anchorage.    (Angle.) 


104 


ORTHODONTIA. 


Fig.  37. 


The  central  and  cuspid  cannot  be  pushed  outward  on  account 
of  this  reenforcement,  and  three  teeth  constitute  the  anchor- 
age instead  of  one.     The  several  parts  of  this  appliance  are 

shown  in  Fig.  36. 

"  Outward  movement,  as  accom- 
plished by  another  simple  means, 
is  as  follows :  A  thin  strip  of  band 
material  is  looped  about  the  mal- 
posed  tooth,  the  ends  resting  upon 
the  labial  surfaces  of  the  adjoining  teeth.  To  one  end  of 
this  strip  is  soldered  a  tube  placed  vertically,  while  to  the 
other  end  a  similar  tube  is  attached  horizontally.  Into  these 
tubes  the  small  traction  screw  is  placed, 
being  bent  to  conform  to  the  shape  of  the 
arch,  and  used  in  this  case  to  push  instead 
of  pull.  The  parts  of  this  device  are  shown 
separately  in  Fig.  37.  The  manner  of  retain- 
ing the  teeth  in  position,  after  correction,  is 
shown  in  Fig.  38. 

"  Rotation  by  this  method,  as  in  most 
others,  is  accomplished  by  the  leverage  and 
elasticity  of  a  metallic  bar  or  wire  attached 
to  the  tooth  to  be  rotated,  and  then  sprung 

around  to  some  firmer  tooth  or  teeth 
at  a  distance.  Fig.  39  shows  a  lateral 
to  be  rotated,  and  the  appliance  in 
position  by  which  it  may  be  accom- 
plished. The  lateral  is  banded  and 
tubed  as  shown  in  the  cut.  The 
second  bicuspid  is  also  banded,  and 
to  secure  greater  resistance,  the  two 
adjoining  teeth  are  made  to  assist  by 
means  of  a  wire  which  passes  through 
a  tube  on  the  palatine  surface  and 
rests  against  the  first  bicuspid  and  first  molar.  On  the 
buccal  side  of  this  same  band,  the  ends  of  the  band  material 


Device  for  Lateral 
Movement. 

Fig.  38. 


Retention. 


Fig.  39. 


Rotation.    (Angle.) 


MATERIALS    AND    METHODS. 


105 


Retainer. 


are  shaped  into  a  latch  or  hook,  with  which  the  rotating 
lever  engages  when  it  is  sprung  around.    The  several  parts 
Fig.  40.  o  f    t  h  i  s    appliance    are 

shown  in  Fig.  40.  After 
the  tooth  is  in  position,  it 
is  retained  by  means  of  a 
short  wire  passing  through 
the  tube,  and  extending 
^iG.  41.  upon  the  central,  as  seen  in  Fig.  41.    This 

wire  is  kept  in  place  by  a  small  pin,  which 
is  tightly  fitted  in  a  small  hole  drilled 
through  both  tube  and  wire,  as  shown. 
"  W,hen  two  teeth  are  to  be  rotated  in 
opposite  directions  at  the  same  time,  as  the  central  incisors, 
double  rotation  may  bo  accomplished  by  one  appliance,  as 
Fig.  42.  shown  in  Fig.   42.     Both  teeth  are 

banded,  and  a  tube  soldered  to  each 
band,  one  being  horizontal  and  the 
other  vertical.  A  piece  of  piano- 
wire  is  bent  to  a  right  angle  at  one 
Double  Rotation.  (Angle.)  ^ud,  and  then  placed  in  position  as 
seen  in  Fig.  43.  The  tendency  of  the  wire  to  straighten 
itself,  will  rotate  both  teeth  at  once.  When  in  position  they 
are  retained  by  substituting  a  non-elastic  gold  wire  for  the 
piano-wire. 

"  Expansion  of  the  arch  is  accomplished  by  banding  and 
Fig.  43.  tubing  the  first  and  last  teeth  of 

those  to  be  moved,  on  each  side, 
and  connecting  them  by  means  of 
a  wire  passed  through  the  tubes. 
To  these  wires,  at  suitable  and 
Double  Rotation.  (Angle.)  Varying  distanccs,  are  soldered 
short  tubes  to  accommodate  the  ends  of  the  piano-wire 
spring  which  is  bent  to  conform  somewhat  to  the  shape  of 
the  arch.  While  the  spring  does  not  give  us  the  power  and 
direct  action  of  the  jack-screw,  it  is  in  many  cases  sufficient 


106 


ORTHODONTIA. 


Fig.  44. 


and  avoids  interference  with  the  tongue  which  necessarily 
accompanies  the  use  of  the  latter. 

"Fig.  44  shows  the  appliance  in  position,  which  is  as  ap- 
plicable to  the  lower  teeth  as  the  upper." 

Retention  is  antici- 
pated and  provided  for, 
by  means  of  the  tubed 
band,  while  the  pin  de- 
vice for  locking  lever 
and  tube  together,  is 
both  novel  and  ingeni- 
ous. Aside  from  these, 
the  method  contains  so 
many  ingenious  modifi- 
cations of  previouslj^ 
known  devices  (as  the 
screw  and  band),  and  is 
composed  of  parts  so 
simple  and  direct  in 
their  action,  that  it  must  necessarily  commend  itself  to 
all  engaged  in  this  line  of  practice.  Other  illustrations  of 
this  method  are  shown  throughout  Part  III. 

The  various  parts  of  the  Angle  appliances  may  be  obtained 
from  the  inventor,  or  from  the  dental  supply  houses.* 

coffin's  method. 

In  a  paper  read  before  the  Dental  Section  of  the  Inter- 
national Medical  Congress,  held  in  London,  in  August,  1881, 
Mr.  Walter  H.  Coffin  explained  his  method  of  correcting 
irregularity  of  the  teeth.  The  method  was  devised  by  his 
father,  and  had  been  in  use  by  father  and  son  for  twenty- 
five  years.  It  was  termed  the  "  Expansion  Method,"  because 
in  nearly  all  cases  coming  under  their  care  a  certain  amount 
of  expansion  had  been  found  necessary  in  connection  with 
other  desired  movements. 

*  Directions  for  constmctuig  the  Angle  and  other  metallic  appliances  will 
be  found  in  Part  IV,  Chap.  V. 


Angle  Device  for  Expansion. 


MATERIALS    AND    METHODS.  107 

The  construction  of  the  appliance  and  the  principle  upon 
which  it  acts  are  exceedingly  simple.  The  power  is  derived 
from  the  elasticity  of  piano-forte  wire,  attached  in  various 
ways  to  a  vulcanite  plate  which  covers  the  arch  (in  an  upper 
case)  and  envelopes  the  posterior  teeth  on  either  side  to  give 
it  firmness  and  fixedness  in  position.  When  it  is  desired 
to  expand  the  superior  arch,  the  wire  is  bent  into  the  fol- 
lowing form  751r  y  lyii^g  o^^  ^<^P  o^  ^^^6  plate  with  the  ends 
embedded  in  it. 

To  produce  lateral  expansion  in  the  lower  jaw,  the  form 
of  the  appliance  is  necessarily  different.  A  simple  vulcanite 
plate  is  made  in  horse-shoe  form,  fitting  the  gum  and  lingual 
surfaces  of  the  teeth,  and  capping  the  molars  and  bicus- 
pids. On  the  lingual  surface  of  this  plate,  lie  two  pieces  of 
piano-wire  suitably  curved,  with  their  ends  embedded  in  the 
rubber. 

Each  of  these  plates,  when  comj)leted,  is  sawn  in  two  along 
the  median  line,  thus  allowing  the  tension  of  the  wire  to  be 
increased  from  time  to  time  by  spreading  ai;)art  the  sections 
of  the  plate. 

The  piano-forte  wire  used  may  be  obtained  from  piano 
factories  or  from  dealers  in  dental  supplies.  It  is  simply 
wire  made  from  the  best  quality  of  steel,  drawn  to  size 
through  draw-plates.  The  quality  of  the  steel,  as  well  as 
the  toughness  of  the  wire,  is  greatly  improved  by  the  suc- 
cessive drawings  to  which  it  has  been  subjected.  For  ordi- 
FiG.  45.  nary  cases  Mr.   Coffin   recommends 

that  the  diameter  of  the  wire  be  be- 
tween three  and  four  one-hundredths 
of  an  inch.  A  lighter  or  heavier 
number  will  yield  respectively  less 
or  greater  pressure, 
pnng.  j^  ^^^  ^^  should  not  be  annealed, 

but  bent  to  shape  as  it  comes.  Mr.  Coffin  recommends  that 
the  wire  be  tinned  after  being  bent  to  shape,  to  j)revent  oxi- 
dation in  the  mouth,  but  this  does  not  ajopear  to  be  nec- 
essary. 


108  ORTHODONTIA. 

A  wire  suitably  bent  to  produce  expansion  of  the  superior 
arch  is  represented  by  Fig.  45. 

The  details  of  the  construction  of  an  expansion  plate  for 
the  superior  jaw,  are  as  follows:  From  an  accurate  impres- 
sion of  the  jaw  and  teeth,  taken  with  plaster  or  modelling 
compound,  a  plaster  model  is  obtained.  Upon  this  a  wax 
base-plate  is  fashioned,  to  cover  all  parts  intended  to  be  cov- 
ered by  the  completed  plate.  The  suitably  bent  wire  is  now 
further  shaped  so  that  it  will  lie  upon  the  exposed  surface 
of  the  base-j)late  and  conform  to  it  as  closely  as  possible  in 
outline.  After  the  ends  of  the  wire  are  attached  to  the  base- 
plate by  means  of  additional  wax,  a  piece  of  tin-foil  (No.  60) 
is  slipped  between  the  wire  and  the  plate  and  its  corners 
bent,  so  that  the  plaster  when  poured  into  the  flask  will 
grasp  and  remove  it  with  the  wire.  The  foil  is  placed  there 
so  that  the  plate  will  have  a  polished  surface  under  the  wire 
after  vulcanization.  The  wax  base-plate  should  now  be 
smoothed  with  a  spatula  and  flasked  in  the  usual  manner. 
In  separating  the  flask,  the  wire  and  tin-foil  will  come 
away  with  the  upper  half,  while  the  model  will  remain  in 
the  lower.  After  removing  the  wax  and  packing  the  rubber, 
the  case  is  vulcanized,  after  which  it  is  polished.  The  com- 
pleted piece  should  now  be  properly  fitted  to  the  patient's 
mouth,  and  the  rubber  covering  the  masticating  surfaces  of 
the  posterior  teeth  so  filed  and  dressed  that  the  cusps  of  the 
occluding  teeth  will  all  strike  the  rubber  at  the  same  time. 

However  many  or  few  of  the  natural  teeth  be  covered  the 
last  ones  in  the  arch  must  always  be  included,  as  otherwise 
they  will  elongate  through  non-occlusion  and  thus  seri- 
ously impair  the  usefulness  of  the  masticatory  apparatus. 
After  the  plate  has  been  fitted  it  should  be  sawn  in  two  with 
a  jeweler's  fine  saw,  the  edges  made  smooth  and  slightly 
rounded,  and  the  case  introduced  into  the  mouth. 

It  is  desirable  to  have  the  patient  wear  the  plate  for  a  day 
without  enlargement,  after  which,  at  intervals  of  a  day 
or  two,  the   tension  of  the  wires   should   be  increased  by 


MATERIALS    AND    METHODS. 


109 


Fig.  46. 


pulling  the  halves  of  the  plate  apart  sufficiently  to  slightly 
increase  the  space  between  them.  When  the  wire  is  heavy, 
-as  is  necessary  where  great  force  is  to  be  exerted,  it  can  be 
best  formed  into  shape  and  afterwards  altered  as  required 
by  means  of  the  ordinary  clasp-bending  pliers.  The  con- 
struction of  the  lower  plate  is  substantially  the  same,  but 
the  wires  lie  against  the  plate  in  a  continuous  smooth  curve, 
instead  of  being  corrugated. 

Figs.  46  and  47  represent  an  upper  and  lower  expansion 

plate  as  described. 
For  cases  where 
expansion  is  not 
needed,  but  simply 
the  moving  of  one 
or  more  teeth,  Mr. 
Coffin  uses  a  solid 
rubber  plate  with 
wires  so  placed  as 
to  produce  the  de- 
sired movements. 
The  construction 
of  this  for  m  of 
plate  is  the  same 
as  those  just  de- 
scribed, with  the 
exception  of  the 
shape  and  arrange- 
ment of  the  wires 
and  the  non-sepa- 
ration of  the  plate. 
A  single  long  piece  of  wire,  bent  at  right  angles  near  one 
end  and  flattened  at  the  other,  is  embedded  at  its  flattened 
end  into  the  plate,  while  the  other  end,  and  a  long  portion 
besides  is  free  and  lies  in  close  contact  wdth  the  plate.  Be- 
fore the  wire  is  attached  to  the  wax  base-plate,  the  plaster 
tooth  representing  the  one  to  be  moved  should  be  cut  away 


Coffin's  Expansion  Plates. 


110 


ORTHODONTIA. 


close  to  its  neck  and  the  bent  end  of  the  wire  laid  upon  it 
so  as  to  cover  the  entire  diameter  of  the  stub  tooth.  In  this 
position  it  is  vulcanized  to  the  plate. 

When  the  plate  is  introduced,  the  wire  will  have  to  be 
drawn  back  with  an  instrument  or  string  before  the  plate 
will  go  into  position.  Once  in  place  and  the  wire  released 
continuous  pressure  will  be  exerted  on  the  mal|)osed  tooth. 
After  the  tension  of  .the  wire  has  been  lessened  by  the  moving 
of  the  tooth,  it  may  be  increased  either  by  bending  the  wire 
where  it  enters  the  plate  or  by  cutting  it  out  and  re-setting 
in  a  different  position. 

Another  and  very  convenient  way  of  lengthening  the 
wires  to  follow  the  moving  tooth,  is  to  slip  a  section  of  plati- 
num or  German  silver  tubing  over  the  end  of  the  wire  and 
soft-solder  it  in  position. 

Where  a  tooth  is  to  be  pressed  outward  the  wire  is  anchored 
in  the  palatal  jDortion  of  the  plate,  but  where  a  tooth  is  to 
be  moved  from  without  inward,  the  wire  should  be  attached 
to  that  portion  of  the  plate  covering  the  buccal  surfaces  of 
the  molars. 

Rotation  is  accomplished  by  combining  the  two  move- 
ments ;  that  is,  by  having 
one  wire  on  the  palatine 
surface  to  press  against 
one  angle  of  the  tooth,  and 
another  on  the  buccal  sur- 
face to  press  against  the 
opposite  angle. 

Two  wires  can  be  in- 
serted to  operate  on  two 
teeth  at  the  same  time, 
either  in  similar  or  oppo- 
site directions.  Fig.  48  represents  a  plate  made  to  press  out- 
ward two  lateral  incisors. 

Many  modifications  of  the  Coffin  plate  have  been  devised 
by  different  practitioners,  some  of  which  are  shown  in 
Part  III. 


Fig.  48. 


Coffin  Solid  Plate. 


MATERIALS    AND    METHODS. 


Ill 


The  originator  claims  for  his  method  and  appUance,  sim- 
plicity, ease  of  construction  and  inexpensiveness,  almost 
universal  range  of  application,  perfect  control  of  force  applied 
and  direct  action,  comparative  painlessness  from  non-irrita- 
tion of  the  soft  tissues,  perfect  fixedness  and  least  unsightli- 
ness,  ease  of  removal  for  cleansing,  and  little  interference 
with  speech  and  mastication. 

Dr.  E.  S.  Talbot  has  designed  a  modification  of  the  Coffin 
piano-wire  spring,  which  consists  in  converting  it  into  a  coil 
at  some  point  of  its  length,  thus  adding,  it  is  claimed,  greater 
elasticity  and  a  wider  range  of  applicability.  Unlike  the 
Coffin  spring  it  may  be  used  without  a  rubber  j)late  and 
without  being  permanently  attached  to  any  appliance.  The 
coil  is  formed  by  bending  the  wire  around  a  mandril  firmly 
driven  into  the  bench  or  properly  secured  in  a  vise. 

The  arms  may  be  bent  or  cut  to  any  length  to  suit  the 
case  in  hand.  They  may  be  used  in  connection  with  a 
rubber  plate,  or  with  bands  of  gold  or  platinum  fastened  to 
the  teeth  with  zinc-phosphate.  With  holes  i:)roperly  drilled 
in  the  bands  or  plate  and  the  arms  fitted  into  them,  the 
spring  will  stay  in  position.  When  the  spring  is  used  with- 
out a  plate  it  may  be  well  to  fasten  the  wire  to  some  of  the 
YiG,  49.  teeth  to  pre- 

vent its  being 
s  wallo  wed. 
Fig.  49  illus- 
trates the  coil 


Talbot  Coiled  Spring. 


spring  in 
some  of  its 
forms.  To 
prevent  the 
spring  from 

rocking  in  the  mouth  the  coil  is  usually  made  to  press  over 
a  button  or  post  suitably  placed  on  the  jDlate  for  that  pur- 
pose. 

The  coiled  spring,  in  many  cases,  possesses  advantages  over 


112 


ORTHODONTIA. 


the  plain  spring  because  it  can  be  effectively  used  where  the 
other  cannot.  It  is  also  more  easily  regulated  as  to  tension, 
and  can  be  readily  replaced  by  a  weaker  or  stronger  one 
should  the  case  require  it. 

jackson's  method. 

Appreciating  the  value  of  piano-wire  as  a  power-yielding 
material,  as  shown  in  the  Coffin  method,  and  realizing  the 
advantage  in  most  cases  of  dispensing  with  the  use  of  a  plate, 
Dr.  V.  H.  Jackson  was  led  to  devise  a  method  of  construct- 
ing regulating  appliances  in  which  piano-wire  was  the  prin- 
cipal and  almost  the  only  material  employed. 

By  suitably  bending  a  length  of  this  wire,  of  medium 
thickness,  in  such  a  way  as  to  pass  around  the  buccal  and 
lingual  surfaces  of  all  the  teeth  in  one  of  the  arches  and 
joining  these  portions  at  convenient  distances  by  short  con- 
necting wires,  a  "  crib  "  or  skeleton-wire  fixture  was  formed 
that  hugged  the  teeth  and  held  itself  firmly  in  place. 

To  this,  as  a  foundation,  additional  wires  were  attached  of 
such  length  and  shape  as  to  bear  and  produce  pressure  upon 
any  teeth  in  the  same  Fig.  50. 

arch  as  it  was  desired 
to  bring  into  proper 
position. 

Fig.  50  shows  the  gen- 
eral appearance  of  the 
"  crib  "  in  its  simplest 
form. 

In  constructing  the 
appliance,  the  plaster 
teeth  of  the  model  are 
first  scraped  near  their  cnb.  (Jackson.) 

necks  on  both  the  buccal  and  lingual  surfaces  so  that  the 
crib,  when  formed,  will  have  to  be  sprung  into  place.  The 
wire  is  now  bent  by  means  of  flat-  and  round-nosed  pliers 


MATERIALS    AND    METHODS. 


11.^ 


Fig.  51. 


SO  as  to  conform  to  the  outline  of  the  teeth  and  touch  all  of 
the  included  ones  at  their  necks. 

To  keep  the  crib  from  impinging  upon  and  irritating  the 
gum,  short  wires  (as  before  stated)  are  formed  to  lie  in  the 
depressions  between  the  masticating  surfaces  of  certain  teeth 
and  are  attached  to  the  main  wire  upon  both  the  buccal  and 
lingual  sides.  These  connecting  wires  are  joined  to  the  base 
wire  by  having  their  ends  bent  so  as  to  grasp  them,  after  which 
the  joints  are  secured  by  means  of  soft-solder  fused  by  either 
the  blow-pipe  or  soldering  iron  while  the  parts  are  in  posi- 
tion on  the  model.  Before  soldering,  the  parts  will  have  to 
be  touched  with  dilute  muriate  of  zinc,  commonly  known 
as  soldering  fluid.  AVrapping  the  joint  with  fine  copper 
wire  before  soldering  greatl}^  facilitates  the  operation. 

The  crib  once  properly  formed,  additional  wires  for  pro- 
ducing pressure  at  any  point  and  in 
any  desired  direction  are  added  to  it  in 
the  same  manner. 

Fig.  51  shows  a  crib  formed  for  and 
attached  to  but  one  side  of  the  arch  for 
the  purpose  of  forcing  a  cuspid  outward 
and  a  lateral  inward  into  line  at  the 
same  time. 

In  some  cases  the  end  of  the  wire 
producing  pressure  is  best  secured  in 
position  by  being  soldered  to  a  band 
to  be  cemented  to  the  tooth  to  be 
moved,  as  shown  in  Fig.  52. 

While  the  appliance  thus  constructed  is  firmly  held  in 
place  by  hugging  the  teeth  above  their  most  prominent  por- 
tions it  is  at  the  same  time  readily  removed  for  the  purpose 
of  bending  the  wire  springs  or  for  alterations  or  new  attach- 
ments. 

Dr.  Jackson  has  recently  simplified  and  improved  his 
appliances  by  discarding  the  crib  formed  of  a  continuous 


114 


ORTHODONTIA. 


Fig.  52. 


piece  of  wire  (whicli  was  oftentimes  difficult  to  construct) 
and  obtaining  his  anchor- 
age by  wire  and  metal  at- 
tachments to  individual 
teeth  instead,  as  shown  in 
Fig.  53. 

In  constructing  these 
.anchorage  appliances,  he 
first  cuts  from  thin  gold, 
block  tin,  tinned  copper, 
German  silver  or  Tagger's 
tin  a  piece  large  enough 
to  cover  the  lingual  por- 
tion of  the  anchor  tooth  and  contours  it  with  the  con- 
pliers  used  in 
and  bridge- 
work.  A  wire  crib  for 
the  same  tooth  is  then 
made  from  a  piece  of 
No.  20  piano-wire  by 
''  first  bending  it  at  right 
angles  (Fig.  54),  leaving 
the  width  between  the 
parallel  sides  equal 
to  the  antero-posterior 
width  of  the  tooth  to  be 
clasped.  The  part  that 
so   bent  with 


Fig.  53. 


Crib  and  Band.    (Jackson. ^ 


touring- 
crow  n 


Fig.  54. 


Anchorage.    (Jackson.) 

is  to   clasp   the  neck  of  the  tooth   is  then 

clasp-benders    that     it    will     be     perfectly 

adapted  to  the  curve  of  the  labial  side  of 

the  tooth,   (Fig.  55.)     Both  arms  of  the  wire 

are  then  bent  at  nearly  a  right  angle  at  a 

proper  distance  to  cause  them  to  pass  over 

the  grinding  surface  of  the  tooth,  and  again  bent  in  the 

same  manner  to  extend  toward  the  neck  of  the  tooth  on  the 

lingual  side.   (Fig.  56.) 


MATERIALS    AND    METHODS. 


11.' 


Fig.  56. 


"  The  ends  are  next  bent  toward  each  other  near  the  gum 
line  over  the  joiece  of  metal  previously  de-  Fig.  s.'s. 

scribed,  as  seen  at  A  in  Fig.  53,  and  tacked 
with  soft  solder." 

If  the  wire  spring  is  to  be  attached  to  the 
teeth  on  the  opposite  side  of  the  arch  a  sim- 
ilarly constructed  crib  should  be  made  for  that 
side.  With  these  two  cribs  in  position  on  the 
plaster  model  the  connecting  wire,  after  being 
suitably  shaped,  is  laid  in  position  and  firmly 
held  while  all  are  joined  together  with  solder. 
The  soldering  is  most  conveniently  accomplished  by  moist- 
ening the  parts  with  dilute  muriate  of  zinc,  laying  upon 
each  joint  a  piece  of  soft  solder  of  suitable  size  and  fusing 
with  a  soldering  iron.  After  this  any  wire  springs  that  may 
be  needed  are  attached  in  the  same  manner. 

The  entire  appliance  being  thus  formed  of  separate  parts 

and  joined  together 
while  in  position  on  the 
model  assures  accuracy 
of  fit  that  could  not  w^ell 
be  obtained  in  any  other 
manner. 

In  other  cases,  where 
it  seems  advisable,  in- 
stead of  a  crib  made  of 
plate  and  wire  as  de- 
scribed, attachment  to 
the  anchor  teeth  is 
made  by  means  of  a 
metal  band  or  collar 
encircling  the  tooth,  to  which  sections  of  metal  tubing  or 
lugs  are  attached  for  the  accommodation  of  the  spring  wire, 
as  shown  in  Fig.  57. 

Some  of  the  numerous  ways  in  which  these  combination 
appliances  may  be  adapted  to  the  correction  of  many  forms 


Fig.  57. 


Wire  and  B^nd  Appliance.    (Jackson.) 


116  OETHODOXTIA. 

of  irregularity  are  shown  in  connection  with  the  practical 
treatment  of  cases  in  Part  III. 

Dr.  Jackson  claims  for  his  method  that  the  appliances  are 
easily  retained,  cause  no  inconvenience  and  do  not  interfere 
with  articulation,  even  when  used  in  both  the  upper  and 
lower  arches  at  the  same  time.  In  addition,  the  model  is 
not  injured  in  making  the  appliance  and  so  may  be  pre- 
served for  future  measurements  and  studv. 


PART  III. 


SPECIFIC  FORMS  OF  IRREGULARITY  AND  THEIR 
TREATMENT. 

While  principles  and  methods  may  be  well  understood, 
illustrations  of  their  application  in  certain  forms  of  irregu- 
larity will  be  necessary  in  order  that  the  student  may 
properly  comprehend  their  practical  relationship. 

So  far  as  ease  or  difficulty  of  treatment  is  concerned,  cases 
of  irregularity  are  naturally  divided  into  two  general  classes ; 
in  one  the  cases'  are  brought  to  our  notice  as  soon  as  the 
irregularity  begins  to  manifest  itself,  while  in  the  other  the 
deformity  is  fully  establishsd  and  confirmed  before  presenta- 
tion for  treatment.  In  the  first  class,  occurring  usually  in 
children,  we  have  the  advantages  of  easy  movement  and 
freedom  from  complications ;  while  in  the  second,  we  have 
to  contend  with  slow  and  difficult  movement  and  a  variety 
of  unfavoring  conditions. 

For  these  reasons  it  is  deemed  advisable  to  treat  of  certain 
forms  of  irregularity,  especially  those  involving  the  six 
anterior  teeth  of  each  jaw,  under  separate  heads,  according 
as  they  present  before  or  after  dentition  is  complete,  for  the 
treatment  in  one  case  will  vary  considerably  from  that 
required  in  the  other. 


117 


CHAPTER  I. 

INCISOR   TEEEH  ERUPTING    OUTSIDE    OR    INSIDE  OP    THE  ARCH. 

Reference  has  already  been  made  to  the  fact  that  normally 
the  permanent  inferior  incisors  erupt  inside  of  the  arch 
and  posteriorly  to  the  deciduous  ones,  while  the  permanent 
superior  incisors  erupt  outside  of  their  deciduous  prede- 
cessors. From  the  limited  space  allotted  to  them,  there 
is  a  stronger  tendency  to  irregularity  on  the  part  of  the 
lower  incisors  than  there  is  on  the  part  of  the  more  favor- 
ably located  superior  ones,  although  the  latter  are  also  often 
found  in  a  crowded  condition,  sometimes  complicated  with 
torsion. 

So  long  as  the  inferior  ones  are  within  the  arch,  even 
though  irregularly  arranged,  they  will  usually  need  no  atten- 
tion on  our  part  until  dentition  is  complete,  and  when  that 
time  arrives  it  will  generally  be  found  that  nature  has  al- 
most, if  not  entirely,  corrected  the  condition. 

So,  also,  where  some  of  the  superior  incisors  erujDt  slightly 
outside  of  the  arch,  they  being  still  in  line  with  spaces 
between  them,  we  need  not  interfere,  for  in  most  cases  the 
force  exerted  by  the  lips  and  the  erupting  cuspids  will  bring 
them  into  normal  position  and  relationship. 

It  not  unfrequently  happens,  however,  that  from  some 
cause  a  superior  incisor  is  deflected  in  its  eruption  and 
appears  inside  of  the  arch,  or  that  an  inferior  incisor  is  found 
to  erupt  outside  of  the  arch.  In  either  case,  treatment  is 
indicated  as  soon  as  the  irregular  tooth  or  teeth  are  suffi- 
ciently erupted  to  enable  us  to  bring  the  proper  force  to  bear 
upon  them. 

One  of  the  earliest  methods  employed  for  releasing  an  in- 
locked  superior  incisor  was  by  the  use  of  what  was  known 

118 


PRACTICAL    TREATMENT.  119 

as  the  "  saddle  and  inclined  j^lane,"  one  form  of  which  is 
shown  in  Fig.  58. 

The  saddle  was  usually  formed  of  metal,  struck  up  to  fit 
jpj^  53  and  cover  all  of  the  lower  incisor  teeth. 

To  this,  at  some  point  of  the  ridge,  was 
M>ldered  an  inclined  piece  of  heavy  metal 
-'.J  arranged  that  the  inlocked  tooth  would 
strike  upon  it  in  mastication  and  be  forced 
outward  into  line. 

Later  the  appliance  was  often  made  of  vulcanite,  and 
while  in  either  form  it  generally  answered  the  purpose  of 
correcting  the  simple  irregularity,  it  was  objectionable  on 
account  of  its  size  and  because  it  was  removable  and  thus 
liable  to  be  lost  or  laid  aside  and  not  worn. 

A  modification  of  and  improvement  upon  the  old  form, 
retaining  its  virtues  and  obviating  its  disadvantages,  was 
devised  by  the  author  many  years  ago.  By  its  use,  when 
attached  to  a  single  tooth,  a  double  movement  is  produced, 
for  while  by  the  action  of  the  plane  the  superior  inlocked 
tooth  is  moved  -outward,  the  lower  outstanding  one,  to 
which  the  plane  is  attached,  is  moved  inward.  When  it  is 
not  desired  to  move  the  lower  tooth  it  can  be  prevented  by 
making  the  appliance  to  include  two  or  more  teeth  and  thus 
offer  more  resistance. 

It  is  constructed  as  follows :  A  band  of  thin  platinum, 
gold  or  German  silver  plate  (No.  29,  B.  and  S.  gauge)  is  bent 
to  encircle  and  fit  the  protruding  lower  incisor,  and  the  ends 
soldered.  ,  A  23iece  of  ordinary  gold  plate  is  then  bent 
double  to  form  a  plane,  and  spread  apart  at  its  ends  to 
grasp  the  band  on  the  lingual  and  labial  surfaces,  to 
which  it  is  soldered.  It  is  next  placed  upon  the  tooth  to  see 
that  the  adjustment  is  correct,  removed,  lined  with  phos- 
phate of  zinc,  and  pressed  permanently  into  position.  If 
the  teeth  are  in  close  contact  it  is  well  to  allow  the  fixture 
to  be  worn  a  day  previous  to  cementing,  for  then  the  teeth 
will   have  been  pressed  apart   and  the  replacement  with 


120  ORTHODONTIA. 

cement  will  be  more  easily  accomplished.  The  cemient  not 
only  lines  the  band,  but  fills  all  the  space  between  the 
Fig.  59.  plane  and  the  tooth,  thus  giving  greater  resist- 
ance and  strength  in  biting.  It  is  shown  in 
position  and  separately,  in  Fig.  59.  Its  advan- 
tages are  its  small  size  and  absolute  fixedness. 
When  the  correction  has  been  accomplished,  it  will 
be  necessary  to  cut  the  band  in  order  to  remove 
Mxed  Plane,  it.  Two  objections  have  been  urged  against  the 
employment  of  inclined  planes  in  any  form :  one,  that  by 
thus  opening  the  bite,  the  2:)osterior  teeth  will  elongate ;  the 
other,  that  the  patient  may  avoid  biting  upon  the  plane  and 
thus  defeat  our  object.  These  objections  have  no  real  valid- 
ity, as  is  shown  by  actual  experience. 

The  short  time  that  the  bite  is  open,  usually  only  a  week 
or  two,  is  not  long  enough  to  permit  of  any  perceptible 
elongation,  while  the  patient  must  and  does  bite  upon  the 
plane  in  mastication,  because  it  is  the  only  point  where 
occlusion  is  possible. 

Another  plan  of  accomplishing  the  same  end  has  been 
suggested  by  Prof.  C.  N.  Peirce.  He  attaches  ligatures  to 
several  or  all  of  the  lower  incisors,  and  makes  these  fast  to 
the  molars  on  either  side.  The  ligatures  being  attached  and 
drawn  tight  while  dry,  will,  under  moisture,  contract  and 
draw  the  incisors  inward.  This  operation  is  continued  until 
the  lower  incisors  reach  a  position  inside  or  back  of  the  mal- 
posed  superior  ones.  The  ligatures  are  then  removed,  and 
the  lower  teeth,  in  gradually  resuming  the  position  they 
formerly  occupied,  will  carry  the  inlocked  superior  ones  with 
them. 

Where,  for  any  cause,  it  is  desirable  to  confine  the  means 
of  correction  to  the  jaw  in  which  the  irregularity  exists,  as, 
for  instance,  where  the  superior  laterals  are  inlocked,  a  sim- 
ple plan  is  to  take  a  piece  of  platinized  gold,  about  one- 
eighth  of  an  inch  in  width  and  long  enough  to  more  than 
cover  the  four  incisors,  and  punch  or  drill  four  holes  in  it, 


PRACTICAL    TREATMENT. 


121 


two  opposite  each  of  the  laterals.  The  bar  being  laid  in 
position  on  the  labial  surfaces  of  the  centrals,  the  laterals 
are  securely  ligated  to  it,  the  thread  passing  through  the 
holes.  The  spring  of  the  bar  and  the  contraction  of  the 
moist  ligatures,  will  move  the  laterals  into  position  in  a 
short  time,  the  ligatures  being  renewed  every  two  or  three 
days. 

A  more  satisfactory  way  of  performing  tliis  operation  is 
to  solder  one  end  of  the  bar  to  a  platinum  band  made  to 
encircle  one  of  the  laterals  and  attached  to  it  by  zinc  cement. 
Arranged  in  this  way,  the  bar  has  but  one  free  end,  which 
is  more  readily  ligated  to  the  other  lateral. 

Fig.  60  illustrates  an  appliance  of  this  character,  that  was 
used  to  bring  out  into  posi-  Fig.  60. 

tion  two  superior  laterals  in 
the  mouth  of  a  girl  ten  years 
of  age.  The  case  was  com- 
plicated by  one  of  the  centrals 
being  slightly  turned  upon 
its  axis. 

A  platinum  band  or  collar 
was  made  to  fit  the  right  lat- 
eral, and  to  its  labial  surface  spring  Bar. 
was  soldered  one  end  of  a  bar  of  spring  gold,  long  enough  to 
extend  over  the  centrals  and  cover  the  opposite  lateral. 
The  bar  was  converted  into  a  hook  at  its  free  end  and  so 
shaped  that  in  its  course  it  touched  only  the  prominent 
edge  of  the  twisted  central.  The  band  was  then  cemented 
to  the  right  lateral,  and  a  section  of  small  rubber  tubing 
passed  under  the  left  lateral  and  caught  in  the  hook.  The 
appliance  thus  operated  in  two  ways  :  First,  to  bring  the 
laterals  out  into  line;  and  next,  to  press  backward  and 
inward  the  protruding  corner  of  the  central. 

Another  way  of  securing  the  same  result  is  by  the  use  of  a 
Coffin  plate  and  suitably-shaped  extension  wires,  as  shown 
in  Fig.  61. 


122 


ORTHODONTIA. 


Fio.  61. 


The  rubber  plate  is  made  to  cover  the  arch  and  enclose 
several  bicuspids  or  molars  on  each  side.  In  each  of  the 
buccal  portions  of  the  plate  a  piece  of  piano-wire  is  im- 
bedded, which  extends 
forward  clear  of  the  teeth 
and  terminates  in  a  curve 
or  hook  opposite  the  tooth 
to  be  moved  outward.  A 
section  of  rubber  tubing  is 
slijDped  over  the  tooth  and 
caught  upon  the  hook. 
The  elasticity  of  the  rub- 
ber added  to  the  spring  of 
the  metal  will  rapidly 
draw  the  tooth  outward 
provided  there  is  sufficient  space  in  the  arch  to  accommo- 
date it. 

slight  spaces  existing  between  the 
superior  incisors  when  recently 
erujited  need  give  us  no  concern 
provided  they  are  in  the  normal  line 
of  the  arch ;  but  it  often  happens 
that  in  addition  to  the  spacing  one 
or  more  of  them  is,  to  a  greater  or 
less  extent,  turned  upon  its  axis,  as 
shown  in  Fig.  62. 

In  other  cases  the  teeth  may  be  in 
contact,  while  one  of  them  is  twisted 
and  overlapping  its  neighbor,  as 
shown  in  Fig.  63.  In  either  case  it  is  quite  probable  that 
the  cutting  edge  of  the  turned  tooth  will  occlude  with  the 
corresponding  surface  of  the  one  in  the  opposite  jaw  at  an 
angle,  and  thus  either  prevent  full  eruption  of  one  or  the 
other  of  the  teeth,  or  temporarily  open  the  bite  and  favor 
undue  elongation  of  posterior  teeth. 

Both  of  these  forms  of  irregularity  should  receive  imme- 


As   already  stated, 
Fig.  62. 


Torsion  with  Space. 


Fig.  63. 


Torsion  with  Overlapping. 


PRACTICAL    TREATMENT. 


123 


diate  attention,  for  at  an  early  age  correction  is  easily  accom- 
i^lished.  Were  the  condition  to  remain  unchanged,  it  would 
necessarily  become  Fig.  64. 

more  complicated  ^  ^-^^if^^ 

from  partial   clos-  Zl(     _^     _J^-^r~~^'J' 

ure  of  the  space 
caused  by  the  lat- 
eral pressure  that 
would  be  exerted 
during  the  erup- 
tion of  neighbor- 
ing teeth. 

Rotation  of  these  Tube,  Band  and  Spring  Appliance.    (Matteson). 

teeth,  as  well  as  of  others,  may  be  accomplished  by  one  of 

the  many  methods  described  in  Chapter  VI. 

Dr.  Matteson  accomplishes  the  same  result  without  the 

employment  of  a  rubber  plate.     He  prefers  to  band  the  first 

deciduous  and  first  „ 

Fig.  65. 

permanent  molars 
and  joining  these 
bands  by  a  con- 
necting strip  on  the 
buccal  surface,  and 
a  piece  of  round 
tubing  closed  at 
one  end  on  the 
palatal  surface,  as 
shown  in  Fig.  64. 
The  incisor  to  be  moved  forward  has  a  band  of  gold  or 
platinum  cemented  to  it,  and  to  this  band,  on  the  palatal 
surface,  is  soldered  a  U-shaped  lug. 

By  inserting  a  piece  of  thin  piano-wire  into  the  tube  and 
springing  its  outer  end  into  the  lug  on  the  incisor  band  the 
tooth  is  readily  forced  into  position. 

Instead  of  the  tulje  and  Avire  he  sometimes  employs  a  thin 
strip  of  platinized  gold  soldered  to  the  bands  and  made  to 


Simple  Spring.    (Matteson). 


124  ORTHODONTIA. 

rest  and  press  against  the  in-lying  tooth,  as  show  in  Fig.  65. 

The  single  appliance  may  be  used  to  press  forward  both 
of  the  incisors  by  arranging  the  strip  of  spring  gold  to  press 
upon  but  one  tooth  until  it  is  in  place,  and  then  altering  its 
form  by  bending  so  that  it  will  exert  its  force  upon  the 
other., 

Other  appliances  of  somewhat  similar  character  will 
readily  suggest  themselves  to  an  inventive  mind. 


CHAPTER   II. 


DELAYED     OR     MAL-ERUPTION    OF     THE     PERMANENT    CUSPIDS. 

The  third  molars  excepted,  the  superior  cuspids  are  usually 
the  last  teeth  of  the  permanent  set  to  erupt,  and  they  almost 
invariably  make  their  appearance  outside  of  the  arch.  AVhen 
there  is  room  in  the  arch  for  their  accommodation  and  they 
erupt  directly  outside  of  it,  we  may  feel  assured  that  in  due 
time  they  will  find  their  way  into  place  unaided.  Where, 
however,  they  erupt  over  the  lateral  incisors,  as  is  sometinies 
the  case,  and  these  incisors  are  in  consequence  Ijeing  forced 
inward,  it  becomes  necessary  for  us  to  interfere  and  endeavor 
to  draw  the  cuspids  toward  their  pro|)er  places.  This  is 
usually  not  a  difficult  matter  when  the  cuspid  crown  is  far 
enough  erupted  to  enable  us  to  exert  pressure  upon  it.  In 
such  a  case,  by  cementing  a  Magill  band  to  the  cuspid  and 
another  to  the  second  bicuspid  or  first  molar,  each  having  a 
pin  or  hook  attached  to  its  buccal  surface,  a  rubber  rino- 
p^  extending   from   hook   to 

hook  will  in  a  short  time 
draw  the  cuspid  back  to  a 
position  opposite  the  space 
it  is  to  occupy,  as  illustra- 
ted in  Fig.  66. 

It   sometimes    happens, 
however,  that  the  cuspids 
are  tardy  in  their  eruption 
and  fail  to  assume   their 
positions  in  the  arch  at  the 
time   they  are  needed  to 
complete  the  row  and  prevent  the  incisors  and   bicuspids 
from  encroaching  upon  the  space  the  cuspids  are  to  occupy- 
In  such  cases  it  is  generally  advisable  to  hasten  their  erup- 

125 


126  ORTHODONTIA. 

tion  by  the  application  of  tractile  force  in  some  manner. 
Where  one-half  of  the  crown  is  through  the  gum  we  can 
attach  to  it  a  Magi  11  band  with  a  pin,  hook  or  other  pro- 
jection upon  it,  and  by  its  assistance  readily  appl}^  power 
to  the  tooth. 

The  author  has  had  several  cases  where  elongation  of  the 
cuspid  was  called  for,  wdien  only  the  cusp  of  the  tooth  was 
visible  through  the  gum.  Here  the  application  of  a  cemented 
band  was  out  of  the  question,  and  attachment  to  the  tooth 
had  to  be  gained  in  another  way.  The  difficulty  was  solved 
by  tying  a  silk  ligature  in  a  half  knot,  passing  it  over  the 
projecting  cusp,  and  then  with  a  small,  flat  plugger,  forcing 
this  ligature  up  under  both  gum  and  alveolus  until  it  encir- 
cled the  neck  of  the  tooth,  when  it  was  drawn  tight  and 
made  fast  with  a  surgeon's  knot.  A  very  small  gold  ring, 
with  a  centre  only  large  enough  to  admit  of  the  passage  of 
silk  floss,  was  then  slipped  over  one  of  the  ends  of  the  liga- 
ture and  tied  so  that  it  would  lie  upon  the  labial  face  of  the 
tooth  near  the  gum.  This  ring  was  allowed  to  remain  with- 
out change  until  the  tooth  was  drawn  into  position.  A 
delicate  vulcanite  plate  was  constructed  to  fit  the  arch,  and 
extend  into  the  space  between  the  lateral  and  first  bicuspid. 
At  this  latter  point  the  plate  was  thickened  until  it  was 
nearly  on  a  level  with  the  cutting  edges  of  the  adjoining 
teeth,  and  made  concave  on  its  most  prominent  part.  A 
rubber  spur  was  also  formed  on  the  plate,  in  a  line  with  the 
cuspid  and  space.  The  plate  being  in  position,  a  rubber 
band  was  passed  over  the  spur  and  drawn  tight  to  the  ring 
on  the  tooth  by  means  of  a  ligature,  the  band  in  its  course 
resting  in  the  notch  of  the  elevation  on  the  plate.  By  this 
arrangement  no  pain  was  inflicted  except  that  incident  to 
forcing  the  ligature  into  j)Osition  under  the  gum,  while  power 
was  exerted  in  a  nearly  direct  line  with  the  long  axis  of  the 
tooth,  and  in  a  gentle,  continuous  manner. 

Another  and  most  excellent  plan  of  securing  attachment 
to  a  partially  erupted  cuspid,  is  that  recommended  by  Prof. 


FiCx.  67. 


PRACTICAL    TREATMENT.  127 

J.  F.  Flagg.  It  consists  in  screwing  a  gold  ring-bolt  or  screw- 
eye  into  the  point  of  the  cusp.  The  screw-eye  can  be  made 
by  soldering  a  small  gold  ring  to  the  end  of  a  section  of 
threaded  gold  wire.  After  the  correction  is  accomplished, 
the  screw  is  removed  and  the  hole  filled  with  gold. 

A  very  simple  and  effective  appliance,  securely  attached 
to  the  teeth,  for  drawing  a  cuspid  down  into  position  has 
been  devised  by  Dr.  Angle,  and  is  shown  in  Fig.  07. 

As  will  be  seen,  the  bicuspid  is  fitted  with  a  metal  band 

to  which  is  soldered  a  short 
piece  of  tubing.  A  wire 
of  suitable  length  is  flat- 
tened at  one  end  and  bent 
into  a  hook  to  engage  with 
the  cutting  edge  of  the 
lateral,  while  the  other 
end  is  bent  at  a  right 
angle  to  fit  into  the  tube 
^K  ,  on  the  bicuspid  band. 
Drawing  down -Cuspid.  (Angle.)  Midway  of  the  length  of 

this  wire  is  soldered  a  small  button.  The  unerupted  cuspid 
has  a  headed  pin  cemented  into  its  labial  surface  or  point 
of  cusp,  and  over  this  pin  and  the  button  on  the  wire  is 
stretched  a  section  of  rubber  tubing  to  produce  the  desired 
tension. 

If  mal-position  of  an  erupting  cuspid  should  be  compli- 
cated with  more  or  less  torsion,  the  correction  of  the  latter 
will  be  best  accomplished  after  the  tooth  is  nearly  or  quite 
in  position. 


CHAPTER  III. 


Fig. 


INCISOR    TEETH    SITUATED    OUTSIDE  OR    INSIDE    OF    THE    ARCH 
AFTER    DENTITION    IS    COMPLETE. 

Irregularities  of  tliis  character  will  require  much  the  same 
treatment  as  similar  cases  occurring  during  dentition,  but  the 
attendant  difficulties  will  be  greater,  owing  to  the  increased 
density  of  the  alveolar  structure  and  the  presence  of  all  the 
teeth,  making  the  obtaining  of  space  more  difficult.  In  the 
lower  jaw,  the  irregularity  in 
most  cases  is  confined  to  one 
or  two  teeth,  standing  either 
anteriorly  or  posteriorly  to 
the  line  of  the  arch.  If 
they  are  located  posteriorly, 
and  the  extraction  of  one  of 
them  be  not  indicated,  room 
should  be  made  (if  it  does 
not  exist)  by  pressing  apart 
the  neighboring  teeth.  After 
this  is  done,  they  may  be  conveniently  forced  into  place  by 
means  of  a  Coffin  plate,  constructed  as  shown  in  Fig.  68. 

When  a  single  lower  incisor  is  locked  inside  of  the  arch 
by  the  over-lapping  of  its  neighbors,  it  is  often  so  firmly 
held  in  its  mal-position  that  all  ordinary  means  will  fail  to 
move  it  unless  space  is  first  provided  for  it  by  lateral  pres- 
sure. This  being  sometimes  difficult  of  accomplishment, 
the  direct  power  of  the  jack-screw  may  be  taken  advantage 
of  in  such  cases  to  overcome  the  difficulty,  as  shown  in 
Fig.  69. 

A  platinum  band  was  constructed  to  fit  the  lateral,  and  on 
its  lingual  surface  was  soldered  a  tongue  of  heavy  plati- 
num, so  formed  that  it  would  lie  in  contact  with  the  tooth 

128 


Coffin  Plate  for  Lower  Incisors. 


PRACTICAL    TREATMENT. 


129 


when  the  band  was  in  position.  Into  this  tongue,  near  its 
free  end,  was  drilled  a  counter-sunk  hole  nearly  deep  enough 
to  pass  through  the  metal.  On  the  opposite  side  of  the 
mouth  the  second  bicuspid  was  similarly  fitted  with  a  band, 
to  which  was  soldered  a  strip  of  platinized  gold  long  enough 
to  cover  the  lingual  surface  of  the  adjoining  molar.  By 
this  means  the  molar  was  made  to  assist  in  resisting  the 
force  to  be  applied  to  the  lateral.  The  bicuspid  band  was 
also  re-enforced  by  an  additional  piece  of  heavy  platinum 

soldered  to  it  at  a  point  diag- 
^^^-  ^^-  onally  opposite  to  the  lateral. 

Into  this  latter  piece  a  hori- 
zontal slot  was  drilled  with 
an  engine-bur,  sufficiently 
deep  and  long  to  receive  the 
fish-tail  end  of  an  ordinary 
nickeled-steel  j  a  c  k-s  crew. 
After  both  bands  were  ce- 
mented in  place  the  jack- 
screw  was  placed  between 
them,  with  the  flat  end  in 
the  bicuspid  band  and  the 
point  resting  in  the  counter-sunk  hole  of  the  lateral  band. 
The  patient  increased  the  tension  of  the  screw  from  day  to 
day  by  turning,  and  in  two  weeks'  time  the  tooth  was  in 
line.  It  was  held  there  until  it  became  firm  by  means  of 
platinum  binding  wire  woven  about  it  and  its  neighbors. 

In  cases  where  it  is  not  deemed  advisable  to  pursue  the 
plan  just  mentioned,  an  excellent  way  of  creating  space  and 
at  the  same  time  moving  an  incisor  outward  into  line  is  by 
the  employment  of  a  double-acting  device,  composed  of  a 
thin  metallic  ribbon  and  spring,  or  bolt  and  nut. 

The  first  recorded  suggestion  of  an  appliance  of  this  char- 
acter appears  in  one  of  Dr.  Farrar's  articles,  published  in 
1884.* 


Jack-Screw  Forcing  Out  Inferior  Lateral. 


*  Dental  Cosmos,  VoL  XXVI.,  p.  672. 


130 


ORTHODONTIA. 


Fig.  70. 


(Angle.) 


Prof.  Angle  employs  a  modified  and  simplified  device,  as 
is  shown  in  the  accompanying  illustration.  It  is  con- 
structed as  follows :  The  ribbon  being  of  sufficient  length  to 
pass  back  of  the  inlocked  tooth  and  rest  slightly  upon  the 
labial  surfaces  of  the  adjoining  teeth,  two  short  tubes  are 
soldered  to  it,  one  at  each  end.  One  of  these  tubes  is  set 
vertically  and  the  other  horizontally.  A  piece  of  steel  wire, 
bent  at  a  right  angle  at  one  end  and  thread- 
cut  and  j^rovided  with  a  nut  at  the  other,  is 
made  to  engage  with  the  tubes,  the  bent  end 
slipping  into  the  vertical  tube  and  the  other 
passing  into  the  horizontal  one,  with  the  nut 
resting  against  its  inner  end.  By  unscrew- 
ing the  nut,  the  ends  of  the  ribbon  are  forced 
apart  and  the  desired  movements  accom- 
plished. Fig.  70  represents  the  appliance  in 
position,  and  Fig.  71  the  separate  parts  of 
which  it  is  constructed.  In  this  device  the  direct  power  of 
the  screw  is  used  to  furnish  the  necessary  pressure. 

Instead  of  the  nut  and  bolt,  Prof.  Matteson  prefers  a  coiled- 
wire  spring  to  operate  upon  the  ends  of  the  ribbon,  as 
shown  in  Fig.  72. 

The  spring  is  made 
from  piano-wire,  No.  14 
or  16,  and  when  in 
place  the  ends  rest  in 
two  short  tubes  soldered 
horizontally  to  the  rib- 
bon near  its  extremities. 
The  tubes  have  slots 
cut  into  their  upper  sur- 

faces    to    prevent    the  Lateral  Movement.    (Matteson.) 

spring  from  pressing  upon  the  gum. 

Should  the  tension  of  the  spring  not  be  sufficient  to  move 
the  tooth  entirely  into  place,  a  longer  one  may  be  substi- 
tuted for  it. 


Fig.  72. 


PKACTICAL    TRIOATMKNT.  131 

As  will  be  noticed,  the  ribbon  has  a  sliort-headed  pin  or 
post  soldered  to  its  exposed  surface  opposite  the  centre  of  the 
inlocked  tooth  to  furnish  a  ready  means  of  ligating  the  band 
to  the  tooth  should  it  be  necessary  to  prevent  its  slipping  out 
of  position. 

When  an  incisor  tooth  in  the  lower  jaw  stajids  outside  of' 
the  arch,  the  -malposition  is  usually  due  either  to  its  having 
been  forced  out  of  place  by  a  superior  one  occluding  back 
of  it,  or  to  unusual  crowding  on  the  part  of  its  neighbors. 
In  the  first  instance,  the  correction  of  the  occlusion  of  the 
superior  tooth  will  usually  press  the  lower  one  into  its 
proper  place,  while  in  the  second  instance,  it  will  be  neces- 
sary to  consider  the  advisability  of  extracting  one  of  the 
crowded  teeth  to  afford  room.  If  such  extraction  be  deemed 
best  the  case  w^ill  be  greatly  simplified  and  the  malposed 
tooth  can  be  brought  into  line  by  some  one  of  the  means 
described  for  drawing  inward  the  superior  incisors. 

If  it  be  deemed  inexpedient  to  extract  one  of  the  crowded 
teeth,  room  will  have  to  be  provided  either  by  expanding 
the  arch  or  by  extracting  a  tooth  or  teeth  back  of  the 
cuspids. 

In  considering  the  matter  of  expansion  of  the  arch  it 
should  be  borne  in  mind  that  the  enlargement  of  one  arch 
may  also  necessitate  the  expansion  of  the  other  in  order  to 
preserve  the  normal  occlusion.  If  both  jaws  will  admit  of 
it  to  advantage,  it  may  be  the  best  plan  to  pursue,  although 
it  will  necessarily  increase  the  labor  and  difficulty  of  the 
operation.  Generally,  if  the  occlusion  and  facial  expression 
be  satisfactory,  it  will  be  far  better  not  to  disturb  the  general 
relation  of  the  teeth,  but  rather  to  extract  one  or  more  of 
the  bicuspids  or  molars.  After  any  of  the  posterior  teeth 
have  been  extracted,  the  anterior  ones  can  be  moved  apart 
or  backward  and  the  irregular  tooth  brought  into  place. 

The  inferior  incisors,  after  being  brought  into  line,  will 
usually  be  retained  in  place  by  the  occlusion  of  the  superior 
teeth,  but  where  this  is  not  the  case,  they  may  be  retained 


132  ORTHODONTIA. 

by  means  of  platinum  binding  wire  woven  about  all  of  the 
incisors  at  or  near  their  necks,  or  they  may  be  securely  lield 
by  means  of  a  ribbon  of  thin  gold  fitting  the  lingual  sur- 
faces of  the  incisors,  to  which  is  soldered  a  platinum  band 
to  encircle  each  tooth  that  has  been  corrected.  The  piece  is 
set  with  phosphate  of  zinc  as  a  lining  to  the  bands. 

For  drawing  or  forcing  into  line  any  of  the  superior 
incisors  standing  outside  of  the  arch,  a  variety  of  methods  is 
at  our  disposal.  In  the  upper  jaw  the  extraction  of  one  or 
more  incisors  to  provide  room  for  other  outstanding  ones  is, 
except  in  rare  cases,  not  to  be  thought  of,  although,  as  just 
stated,  in  the  lower  jaw  extraction  may  often  be  advantage- 
ously resorted  to.  The  greater  conspicuousness  of  the  su- 
perior incisors,  and  the  difference  in  size  between  the  centrals 
and  laterals  would  cause  the  absence  of  any  one  of  them  to 
be  most  noticeable.  Rare  cases  occur,  however,  in  which 
such  extraction  is  justifiable,  as  already  described,  but  a 
wise  discrimination  must  be  exercised  in  regard  to  the  mat- 
ter, as  otherwise  a  greater  deformity  is  likely  to  be  created 
than  the  one  already  existing.  Where  space  is  needed  in 
the  arch  for  the  outstanding  tooth  or  teeth  and  expansion  of 
the  arch  is  not  indicated,  we  may  obtain  it  bj""  extraction 
back  of  the  cuspids,  or  where  the  lack  of  space  is  slight  in 
amount  it  may  be  secured  by  simply  exerting  pressure 
upon  the  adjoining  anterior  teeth.  A  simple  way  of  produc- 
ing this  pressure  is  by  the  use  of  compressed  wood,  as 
described  on  page  78. 

Another  plan  is  by  means  of  a  vulcanite  plate  to  which 
are  attached  gold  or  steel  wires  so  arranged  that  their  free 
ends*  when  drawn  together  and  inserted  in  the  space  intended 
to  be  widened,  will  press  the  adjoining  teeth  farther  apart. 

Still  another,  without  the  use  of  a  plate,  which  the  author 
has  found  very  effective,  consisting  of  platinum  bands  at- 
tached to  the  teeth  to  be  moved,  witli  a  piano-wire  spring 
acting  between  them,  is  described  and  illustrated  in  part 
III,  chapter  VII. 


PRACTICAL    TREATMENT. 


133. 


Dr.  Farrar  recommends  for  the  same  purpose  a  delicate 
jack-screw  with  crutcli  ends  to  fit  the  teeth  to  he  separated. 
Prof.  Goddard  employs  for  the  same  purpose  an  appliance, 
as  shown  in  Fig.  73,  and  constructed  as  follows :  — 

The  two  teeth  bordering 
the  space  are  encircled  by 
bands  having  short  open 
tubes  soldered  to  their  labial 
surfaces  in  a  horizontal  posi- 
tion. Through  these  tubes 
k\  is  passed  a  threaded  wire 
having    two    nuts   upon    it. 

Appliance  for  Separation.    (Goddard.)       Q^^^    ^f  ^j^gg^    jg    designed   tO 

simply  offer  resistance,  while  the  other,  by  being  turned, 
will  gradually  force  the  teeth  apart. 

After  the  desired  space  has  been  obtained,  the  inlockcd 
tooth  may  be  brought  into  pjlace  by  some  one  of  the  methods 
about  to  be  described. 

In  devising  appliances  for  moving  the  superior  incisor 
teeth  either  inward  or  outward  into  line,  due  consideration 
must  be  given  to  the  occlusion.  To  avoid  conspicuousness, 
it  is  desirable  to  have  the  operating  appliances  placed  within 
the  arch,  but  very  frequently  the  occlusion  of  the  lower  teeth 
will  interfere  with  such  arrangement.  In  the  latter  case 
they  may  be  so  constructed  as  to  operate  from  the  outside. 

One  of  the  simplest  methods  for  moving  one  or  more  in- 
cisors outward  into  line  is  by  the  employment  of  the  Coffin 
solid  plate,  as  shown  in  Fig.  48.  The  only  difficulty  met 
with  by  the  author  in  the  use  of  this  form  of  plate  has  been 
where  the  teeth  to  be  moved,  although  inside  of  the  arch, 
stand  perpendicularly  or  incline  slightly  forward.  In  these 
cases  the  free  ends  of  the  wires,  after  being  pressed  up  into 
position  on  the  teeth,  are  frequently  thrown  down  toward 
the  cutting  edge  by  the  force  of  the  spring  operating  upon 
an  inclined  surface.  When  great  inconvenience  arises 
from  this  cause,  it  may  be  remedied  by  cementing  a  nar- 


134 


ORTHODONTIA. 


row  platinum  band  about  midway  of  the  crown  of  the  tooth 
to  be  moved,  and  placing  the  end  of  the  wire  spring  above  it. 
Another  plan  for  moving  outward  any  or  all  of  the  supe- 
rior incisors,  is  by  means  of  a  plate  constructed  as  shown  in 
Fig.  74. 


A   thin   vulcanite  plate 
Fig.  74. 


IS 


Vulcanite  Plate  with  Screws. 


made  to  cover  the  roof  of 
the  mouth  and  cap 
the  bicuspids  and 
molars ;  opposite  the 
tooth  or  teeth  to  be 
moved,  the  plate  is  al- 
lowed to  come  nearly 
down  to  their  cutting 
edges.  Directly  oppo- 
site to  the  center  of 
each  of  these  teeth,  a 
hole  is  drilled  entirely 
through  the  rubber 
to  receive  a  piece  of  screw  wire  long  enough  to  pass  through 
and  project  a  little  beyond  the  i^late.  In  springing  the 
plate  into  position  the  slightly  projecting  ends  of  the 
screws    will    press  yig.  75. 

against  the  teeth 
and  they  will  be 
moved  forward. 
A  half  turn  of  the 
screws  every  day 
will  soon  force  the 
teeth  into  position. 
Dr.  Dodge  *  sug- 
gests the  employ- 
ment of  a  hollow 
metal  screw  tipped 
with  gutta-percha 

at  its   exposed  end  Moving  centrals  Outward.    (Matteson.) 

used  in  connection  with  a  vulcanite  plate,  as  just  described, 

*  Dental  Cosmos,  Vol.  XXXI.,  i5.  772. 


PRACTICAL    TK EATM ENt. 


135 


Fig.  76. 


claiming  for  it  greater  friction  in  contact  with  the  tooth  and 
non-liability  to  injury  of  tooth  substance. 

Less  cumbersome  than  ruljber  plates  and  more  positive 
and  satisfactory  in  the  majority  of  cases  are  appliances  con- 
structed entirely  of  metal. 

Fig.  75  shows  one  of  this  character  designed  by  Prof.  Mat- 
teson,*  somewhat  on  the  Angle  plan,  for  the  purpose  of 
moving  forward  two  inlocked  superior  central  incisors.  As 
will  be  seen,  it  is  firmly  attached  to  the  anchor  teeth  by 
cemented  bands  and  is  operated  by  turning  the  nuts  wliich 
rest  against  tubes  soldered  to  the  anchor  bands. 

Should  the  occlusion  not  permit  the  use  of  the  appliance 
just  described,  the  same  end  may  be  attained  by  employing 
a  fixture  devised  by  Dr.  Kirk  f  and  illustrated  in  Fig.  76. 

It  consists  of  a  nar- 
row silver  plate 
swaged  to  fit  and 
partly  cover  the  roof 
of  the  mouth,  to 
which  are  attached 
two  broad  clasps  of 
platinized  gold  fit- 
ting the  first  molars. 
To  the  buccal  sur- 
faces of  these  clasps 
are  soldered  tubes 
closed  at  their  distal 

Plate,  Band  and  Bar  Appliance.    (Kirk.)  ^^^^-j^    ^^     receivC    a 

gilded  piano-wire,  bent' to  conform  to  the  outline  of  the  arch, 
but  slightly  longer. 

When  in  position,  the  inlocked  centrals  are  tightly  ligated 
to  the  wire  immediately  in  front  of  them,  which  by  its  elas- 
ticity draws  them  forward. 


*  Dental  Review,  Jiily,  '92,  p.  564. 
^Dental  Cosmos,  Vol.  XXXIII.,  p.  908. 


136 


ORTHODONTIA. 


Fig.  77. 


Another  appliance,  simple  in  construction  and  not  inter- 
fering with  occlusion,  designed  to  draw  one  central  outward 
into  line  and  at  the  same  time  press  the  adjoining  promi- 
nent one  back  into  place,  is  shown  in  Fig.  77. 

It  was  devised  by  Dr.  Jackson  and  is  constructed  after  his 

method.  The  first 
molar  is  fitted  with  a 
crib  to  which  the  ex- 
tending spring  wire  is 
attached.  This  engages 
at  its  free  end  with  a 
tubed  band  cemented  to 
the  inlying  central,  and 
in  its  course  rests  upon 
and  presses  against  the 
prominent  central.  A 
double  movement  is 
thus  produced  and  the 
power  of  the  spring  may  be  increased  as  desired  by  straight- 
ening its  curve. 

Still  another  device,  even  more  simple  than  the  preceding 

Fig.  78. 


Crib,  Band  and  Spring  Devise.    (Jackson.) 


one,  for  moving  ^for- 
ward an  inlocked 
incisor,  is  illustrated 
in  Fig.  78. 

It  also  is  one  of  Dr. 
Jackson's,    and    con- 

S  i  S  t  S      simply     of     a  Tubed-Band  and  Spring.    (Jackson.) 

tubed-band  attached  to  the  malposed  tooth  and  an  ingeni- 
ously arranged  wire  spring  to  furnish  the  motive  power. 
The  spring  is  formed  by  bending  a  piece  of  piano-wire 


PRACTICAL    TREATMENT.  137 

into  the  form  of  a  loop  with  one  end  much  longer  than  the 
other,  and  both  of  them  suitably  curved  to  follow  the  out- 
line of  the  arch.  The  longer  arm  of  the  spring  should  at 
least  be  long  enough  to  cover  the  surfaces  of  three  teeth  to 
furnish  proper  support. 

In  adjusting  the  spring,  the  longer  arm  should  be  next 
to  the  gum  while  the  shorter  one  is  being  inserted  into  the 
tube,  then  by  turning  it  downward  the  whole  appliance 
comes  into  proper  position  with  the  shorter  arm  acting  as  a 
spring  to  draw  the  incisor  outward. 

When  the  tooth  is  in  place  it  may  be  retained  by  insert- 
ing a  short  wire  into  the  tube  and  allowing  it  to  rest  upon 
the  labial  surfaces  of  the  two  adjacent  teeth. 

■  When  sufficient  time  has  been  allowed  for  the  tooth  to 
become  firm,  (never  less  than  six  months)  the  retainer  should 
be  carefully  removed.  For  a  few  months  afterward  the 
patient  should  be  seen  once  a  week,  in  order  to  ascertain 
whether  the  tooth  is  remaining  in  its  new  position.  Should 
it  manifest  a  tendency  to  recede,  the  retainer  must  again  be 
placed  in  position  and  kept  there  for  a  further  period  of 
three  months  or  more. 

By  thus  carefully  watching  a  case  after  its  supposed  com- 
pletion, we  may  often  avoid  the  loss  of  some  of  the  ground 
we  have  gained. 


CHAPTER  IV. 

CUSPID    TEETH    SITUATED    OUTSIDE    OR    INSIDE    OF    THE    ARCH. 

Of  the  various  forms  of  irregularity  that  present  for  treat- 
ment, none  perhaps  is  more  common  than  that  in  which  the 
cuspid  teeth  are  located  outside  of  the  arch.  The  cause 
most  frequently  responsible  for  this  condition  is  the  pre- 
mature extraction  of  the  temporary  cuspids,  although  it  is 
often  caused  by  delayed  eruption  of  the  permanent  ones,  and 
by  the  lack  of  accommodation  a  small  arch  sometimes  affords 
for  the  full  complement  of  teeth.  The  cuspids  (superior) 
being  among  the  later  teeth  to  appear,  often  find  their  terri- 
tory pre-occupied  by  the  earlier  arrivals.  Frequently, 
though  not  always,  the  mal-position  of  the  cuspids  is  associ- 
ated with  like  mal-position  of  certain  neighbors,  usually  the 
central  and  lateral  incisors.  The  irregularity  of  these  adjoin- 
ing teeth  is,  in  most  cases,  brought  about  by  the  pressure  of 
the  cuspids  in  their  attempt  to  occupy  their  places  ;  for,  pre- 
vious to  their  appearance  there  is  no  inducement,  if  the 
occlusion  be  normal,  for  the  incisors  to  vary  much  from  their 
true  positions.  The  fact  should  not  be  overlooked  that  all 
teeth  in  erupting  are  impelled  by  a  strong  hidden  force  to 
seek  their  proper  positions  in  the  line  of  the  arch,  and  in  no 
teeth  is  this  persistence  more  plainly  or  powerfully  exhibited 
than  in  the  cuspids. 

The  conditions  being  favorable  each  tooth  will  naturally 
assume  its  place  in  line,  and  should  obstructions  interfere 
it  will  strive  to  overcome  them  ;  but  the  cuspid  teeth  will,  if 
necessary,  exert  a  power  far  exceeding  that  of  any  of  the 
other  teeth  in  their  efforts  to  gain  their  proper  positions  in  the 
arch.  To  this  end  incisors  are  often  disarranged,  and  bi- 
cuspids forced   inward  or  outward.     This  wonderful  force 

138 


PRACTICAL    TREATMENT,  139 

exerted  by  tlie  cuspids,  may  well  be  illustrated  by  a  case 
which  occurred  in  the  practice  of  the  auttior  many  years 
ago: 

•  The  patient  was  a  young  lady  about  fifteen  years  of  age, 
in  whose  upper  jaw  a  cuspid  had  erupted  outside  of  the  arch, 
causing  projection  of  the  lip.  All  of  the  other  teeth  were 
regular,  but  the  bicuspids  and  molars  on  the  affected  side 
were  somewhat  in  advance  of  their  true  positions,  and  there 
was  consequently  very  little  space  in  the  arch  for  the  accom- 
modation of  this  cuspid.  The  first  molar  on  the  same  side 
was  badly  decayed,  so  it  was  decided  to  extract  it  prelimi- 
nary to  making  room  for  the  cuspid.  An  appliance  was  then 
attached  to  the  second  molar  and  second  bicuspid,  intended 
to  draw  the  latter  tooth  backward.  The  patient  left  with 
this  fixture  in  position  and  did  not  return  until  eighteen 
months  later,  when  it  was  noticed  that  both  bicuspids  had 
moved  backward  and  the  cuspid  occupied  its  normal  posi- 
tion in  the  arch.  It  transpired  that  the  appliance,  having 
caused  some  pain,  was  removed  by  the  patient  two  days  after 
it  had  been  placed  in  position.  The  correction  of  the  irregu- 
larity had  been  entirely  accomplished  by  the  cuspid  forcing 
its  way  into  place  and  crowding  the  bicuspids  backward  in 
the  effort. 

To  obtain  space  for  the  accommodation  of  the  cuspid  when 
it  is  situated  outside  of  the  arch,  we  usually  have  to 
decide  between  the  enlargement  of  the  arch  and  the  extrac- 
tion of  a  tooth  anterior  or  posterior  to  it.  If  the  upper  arch 
is  contracted  and  will  admit  of  expansion  to  advantage,  it 
may  be  done  by  one  of  the  methods  described  in  Chapter 
A'^II.  of  this  part ;  but  if  this  be  not  indicated,  we  will  have 
to  decide  upon  the  extraction  of  a  bicuspid  or  lateral  in 
order  to  obtain  space. 

A  careful  consideration  of  the  rules  governing  extraction, 
Part  I.,  Chapter  VII.,  will  greatly  assist  the  operator  in 
deciding  which  tooth  to  extract. 

It  very  frequently  happens  that  the  space  in  the  arch  in- 


140 


ORTHODONTIA. 


tended  to  accommodate  the  cuspid  is  nearly,  but  not  quite, 
sufficient.  In  such  cases,  slight  additional  space  may  gen- 
erally be  gained  by  pressing  apart  the  adjoining  teeth  with 
the  fixture  shown  in  Fig.  123. 

Room  having  been  provided,  the  cuspid  tooth  may  be 
brought  into  place  by  one  of  several  methods  that  are  equally, 
effective  in  the  upper  and  lower  jaws.  Outstanding  cuspids 
are  usually  situated  a  little  in  advance  of  their  normal  posi- 
tions, so  that  in  bringing  them  to  place  we  must  exert  force 
in  a  backward  as  well  as  inward  direction. 

Where  from  the  appearance  of  the  teeth  and  the  surround- 
ing parts  it  seems   probable  that  great  force  will   not   be 

required,  a  cuspid  may  fre- 
quently be  drawn  inward 
by  so  simple  a  means  as 
that  shown  in  Fig.  79. 

In  this  case  a  platinum 
band,  with  a  pin  on  its 
labial  face,  was  cemented 
to  the  outstanding  cuspid. 
To  the  first  bicuspid  on 
the  opposite  side  was  fitted 
a  similar  band  with  a 
small  gold  hook  on  the  palatine  surface  and  a  bar  of  platin- 
ized gold  on  the  buccal  surface  long  enough  to  extend  to  and 
rest  upon  the  adjoining  cuspid  and  second  bicuspid.  This 
provided  the  resistance  of  three  teeth,  whilst  attachment 
was  made  to  but  one.  A  light  vulcanite  plate  was  made  to 
cover  the  arch,  so  as  to  protect  it  from  the  irritation  of  the 
rubber  ring,  which  was  stretched  from  band  to  band.  The 
operation  of  bringing  the  tooth  into  line  was  somewhat  slow, 
occupying  some  four  or  five  weeks'  time,  but  the  object  was 
satisfactorily  accomplished. 

Where  the  movement  to  be  effected  is  more  backward  than 
inward,  it  may  often  be  very  satisfactorily  and  easily  accom- 
plished by  the  simple  appliance  shown  in  Fig.  80. 


Ml  t  il  1 


N    mil  lail  1    1  ian- 


PRACTICAL    TREATMENT. 


141 


Fig.  80. 


A  platinum  band,  with  short  gold  wires  soldered  to  the 
buccal  and  lingual  surfaces,  is  cemented  to  the  tooth  to  be 
moved,  while  a  similar  one  is  attached  to  a  molar  or  other 

anchor  tooth.  The  wires 
on  the  anterior  band  are 
bent  forward,  and  those  on 
the  posterior  one  are 
curved  backward.  Two 
rubber  rings,  caught  over 
the  gold  hooks,  connect 
the  two  bands  and  yield 
the  tractile  power  required. 
These  rubber  rings  can  be 
removed  and  replaced  for 

Author's  Appliance  for  Retraction.  clcansing  the  tcCth,  Or  Can 

be  renewed  at  will  by  the  patient.  Two  rings  can  be 
attached  to  each  pair  of  hooks,  if  greater  power  be  required, 
or  the  same  object  can  be  attained  by  cutting  wider  rings 
from  thicker  tubing. 

Another  simple  way  of  bringing  about  the  same  move- 
ment, is  by  means  of  the  Coffin  plate  with  the  wire  or  wires 
attached  to  the  buccal  portion  and  extending  forward  until 
their  free  ends  rest  upon  the  teeth  to  be  moved.  Ordinarily, 
the  pressure  to  be  exerted  by  them  would  ,be  inward  only ; 
but  by  bending  their  ends  into  the  form  of  partial  hooks,  so 
as  to  engage  with  the  mesial  surfaces  of  the  teeth,  an  addi- 
tional backward  pressure  is  obtained. 

In  most  cases,  however,  greater  force  than  that  exerted  by 
a  rubber  band  or  spring  wire  will  be  necessary  to  draw  a 
cuspid  into  place,  especially  if  it  be  large  and  firmly  im- 
planted. In  such  event  the  power  exerted  by  a  screw  in 
some  form  will  probably  yield  the  best  results. 

One  of  the  simplest  and  best  appliances  for  drawing  a 
cuspid  backward  and  inward  into  line  is  that  devised  by 
Prof.  Angle  and  shown  in  Fig.  81. 

The  first  molar  is  encircled  by  a  metal  band,  to  which 


142 


ORTHODONTIA. 


on  its  palatal  surface  is  soldered  a  long  piece  of  tubing  to 

accommodate    the     traction  Fig.  81. 

screw. 

The  cuspid  is  also  encir- 
cled by  a  band  with  a  short 
tube  soldered  horizontally  to 
it  on  its  distal  surface  with 
which  the  bent  end  of  the 
traction  screw  engages. 

The  nut  operating  against 
the  distal  end  of  the  long 
tube  will  rapidly  move  the 

cuspid  into  position.  Retraction  of  Cuspid.    (Angle.) 

Fig.  82  illustrates  another  appliance  of  Prof.  Angle's,  very 
similar  in  character,  but  with  the  tube  and  screw  located 
jPjo._  82.  upon  tlie  outside  of  the 

arch. 

It  will  be  noticed  that 
on  the  left  side  the  short 
pipe  or  tube  is  attached 
to  the  cuspid  band  at 
the  mesio-buccal  angle 
of  the  tooth  in  order  to 
rotate  it  as  well  as  draw 
it  backward,  while 
upon  the  right  side  the 
screw  is  hooked  over  a 
spur   upon   the   cuspid 

Backward  Movement  and  Rotation.  (Angle.)       band  to  accomplish  the 

same  purpose  more  conveniently. 

Dr.  Farrar's  device  for  effecting  the  same  movement  is 
shown  in  Fig.  83. 

It  consists  of  a  narrow  ribbon  of  gold,  long  enough  to  en- 
close the  cuspid  tooth  and  some  tooth  back  of  the  space  it 
is  to  occupy.  The  ends  of  this  ribbon  nearly  meet  on  the 
buccal  side  of  the    teeth,  and  after  being  reenforced  with 


PRACTICAL    TREATMENT. 


Uc 


Fig.  83. 


studs  of  heavy  gold,  the  anterior  one  being  simply  drilled 
and  the  posterior  one  drilled  and  threaded,  they  are  con- 
nected by  means  of  a 
gold  screw.  The 
turning  of  the  screw 
brings  the  ribbon 
ends  nearer  together, 
and  causes  corres- 
ponding traction  on 
the  misplaced  tooth. 
The  ribbon,  at  suita- 
ble places,  has  ears 
or  tips  attached  to  it, 
intended  to  rest  U})on 
the  masticating  or 
inclined   surfaces    of 

Fariai  .  Traction  Appaiatus.  the    enclosed    teeth 

and  prevent  the  band  from  slipping  up  and  irritating  the 
gum. 

Prof.  E.  T.  Darby's  plan  for  producing  the  same  movement 
is  by  the  use  of 
a  rubber  plate, 
a  gold  encase- 
ment for  the 
cuspid  and  a 
gold  screw  for 
connecting  the 
two  and  produc- 
ing the  required 
tension.  Fig.  84 
is  drawn  from 
one  of  his 
models,  and  re- 
presents the  fixture  in  position.  The  case  was  that  of  a 
young  lady,  fourteen  years  of  age,  who  applied  for  the  cor- 
rection  of   irregularity  of  the  anterior  teeth.     As  will  be 


Fig.  84. 


Daiby's  Appliance  foi  Retraction 


144  ORTHODONTIA. 

noticed  in  the  illustration,  both  laterals  and  the  right  cen- 
tral were  inside  the  proper  line  of  the  arch,  while  the  left 
central  was  outside  of  it.  Space  was  needed  to  bring  these 
teeth  into  position,  and  to  obtain  it  the  left  cuspid  had  to  be 
moved  backward  in  the  arch.  Opportunity  for  so  doing 
was  afforded  by  the  absence  of  the  first  bicuspid. 

To  move  the  cuspid  backward,  and  to  assist  in  accomplish- 
ing other  movements,  a  rubber  plate  Covering  the  arch  and 
capping  the  molar  teeth  was  constructed,  and  into  it  on  the 
buccal  surface  was  inserted  a  gold  stud  or  ear,  drilled  and 
tapped.  A  gold  helmet  to  cover  the  entire  crown  of  the 
cuspid  was  then  constructed,  with  a  projection  on  the  labial 
surface  drilled  for  the  passage  of  the  traction  screw.  After 
this  helmet  was  cemented  in  place  with  phosphate  of  zinc, 
and  the  plate  inserted,  the  two  were  connected  by  means  of 
a  long  gold  screw.  Twice  each  day  this  screw  was  turned, 
until  the  cuspid  was  brought  almost  into  contact  with  the 
second  bicuspid. 

While  this  movement  was  progressing,  other  objects  were 
being  accomplished.  The  rubber  plate  when  first  inserted 
had  a  piano-wire  spring  attached  to  its  palatine  surface  to 
force  forward  the  right  central.  This  accomplished,  the 
spring  was  removed  and  rubber  added  to  the  plate,  to  keep 
this  tooth  in  its  new  position.  •  Two  new  piano-wire  springs 
were  next  inserted  to  spread  apart  and  press  forward  the 
laterals,  as  shown  in  cut.  They  were  brought  into  position 
by  the  time  the  cuspid  had  been  drawn  sufficiently  back- 
ward. 

The  helmet  and  screw  were  now  removed  and  a  piece  of 
piano-wire,  doubled  and  bent  to  proper  shape,  was  inserted 
in  the  hole  of  the  gold  stud  in  the  rubber  plate,  in  such  a 
way  that  the  end  would  rest  upon  the  outstanding  central 
and  force  it  into  line. 

The  case  as  corrected  is  shown  in  Fig.  85.  The  entire 
work  of  correction,  with  its  varied  movements,  occupied 
but  five  months'  time,  and  was  accomplished  by  the  use  of 


PRACTICAL    TREATM  KNT. 


145 


J  \ 


) 


I 


Corrected  Case. 


a  single  plate  with  its  (liUcreiit  uttaclimont.s.     To  retain  the 

teeth   in   position    a  ^i^i.  85, 

rubber    plate    was 

worn  covering   the 

arch   and    having    a 

gold  T  inserted   to 

pass  between    the 

centrals. 

Where  the  occlu- 
sion of  the  teeth 
would  not  contra- 
indicate  its  emplo)-- 
ment,  an  outstanding- 
cuspid  maybe  drawn 
inward  by  means  of  a  screw  operating  between  the  tooth  to 
be  moved  and  those  used  as  anchorages. 

Fig.  86  represents  a  case  of  this  character,  where,  in  addi- 
tion to  the  firmness  of  the  tooth,  the  j^atient  resided  at  such 
a  distance  from  the  dentist  that  a  visit  to  him  could  be  made 

only  at  intervals  of  tw^o  or 
three  weeks.  It  was  there- 
fore necessary  to  devise  an 
appliance  of  such  charac- 
ter that  it  could  not  be 
removed  or  misplaced,  and 
with  a  sufficiency  of  power 
that  might  be  regulated 
by  the  patient  herself. 
The  appliance  shown  in 
cut,  consists  of  two  plati- 
num bands  made  to  fit  the 
Gold  isux  and  Screw  Drawing  in  Cuspid.  misplaccd  cuspid  and  Op- 
posite molar  respectively,  and  cemented  to  these  teeth.  To 
the  palatine  surface  of  each  of  these  bands  was  soldered  a 
gold  ring,  which  served  as  point  of  attachment  for  the  gold 
box  and  screw,  which  operated  between  them. 


Fig:  86. 


146 


ORTHODONTIA. 


Fig.  87. 


One  end  of  the  gold  box  was  bushed  and  thread-cut  to 
receive  the  gold  screw,  which  at  the  opposite  end  was  bent 
into  the  form  of  a  hook  to  engage  with  the  ring  on  the  cus- 
pid band.  The  other  end  of  the  box  was  fitted  with  a  smooth 
gold  wire,  with  a  head  on  one  end  to  serve  as  a  swivel, 
and  a  hook  on  the  other  to  attach  to  the  ring  on  the  molar 
band.  Turning  the  box  with  a  wrench  drew  the  screw  in- 
ward, and  with  it  the  cuspid  tooth.  Using  a  single  molar 
for  anchorage  in  the  movement  of  a  cuspid  was  scarcely  in 

accord  with  correct  prac- 
tice, but  in  this  case  there 
was  no  alternative.  In 
d  rawing  the  cuspid  to 
place  the  molar  was  also 
moved  somewhat  inward 
and  forward,  but  it  soon 
resumed  its  former  posi- 
tion after  being  relieved 
from  duty.    The  corrected 

Completed  Case  with  Retainiug  Appliance,      tootll  WaS  retained  in  place 

by  having  cemented  to  it  the  small  band  and  bar  appli- 
ance shown  in  position  and  separately  in  Fig.  87. 

Another  appliance 
of  the  same  general 
character,  but  differ- 
ent in  construction, 
and  d  e  s  i  g  n  e  d  by 
Prof.  Angle,  is  illus- 
trated in  Fig.  88.  It 
is  described  as  fol- 
lows : — 

"  The  cuspid  tooth 
is  banded  and  a  piece 

Combination  Appliance  for  Drawing  m  Cuspid  (Angle.)    Q-f"    o'old    wirC      bent 

sharply  at  right  angles,  is  hooked  into  a  pipe  soldered  to 
the  surface.     The  other  end  of  the  wire  is  soldered  to  a  pipe 


PRACTICAL    TREATMENT.  147 

through  which  the  small  traction  screw  is  slipped,  and 
against  which  the  nut  works. 

"  The  other  end  of  the  traction  screw  is  hooked  into  a 
pipe,  soldered  to  a  band,  encircling  the  first  molar.  The  an- 
chorage of  this  tooth  is  further  reinforced  by  a  piece  of  the 
gold  wire,  which  is  slipped  through  a  tube  soldered  to  the 
buccal  surface  of  this  band,  the  end  of  the  wire  resting 
against  the  adjoining  teeth. 

"  If  the  tongue  becomes  abraded  by  the  end  of  the  screw 
as  it  emerges  from  the  nut,  a  very  nice  way  of  protecting  it, 
as  in  all  similar  cases,  is  for  the  patient  to  lay  over  the  end 
of  the  screw  a  very  small  piece  of  the  very  common  article 
known  as  chewing  gum." 

Occasionally  it  is  possible  to  move  a  cuspid  inward  and 
at  the  same  time  provide  room  for  its  accommodation  by 
pressing  the  adjoining  teeth  apart. 

Fig.  89  shows  an  ap- 
pliance for  this  purpose 
devised  and  used  suc- 
cessfully by  Prof.  God- 
dard. 

It  was  designed  to 
operate  upon  the  prin- 
ciple of  a  double  wedge, 

the     cuspid     serving     as       Appliance  for  Drawing  in  Cuspid.    (Goddard.) 

one  wedge  and  the  V-shaped  strip  of  metal  as  the  other.  A 
nut  and  bolt  operating  between  the  two,  as  shown,  furnished 
the  motive  power.  The  strip  was  altered  in  form  as  the 
work  progressed,  always,  however,  retaining  its  wedge 
shape. 

Prof  Matteson  *  illustrates  and  describes  the  use  of  a 
novel,  but  simple,  fixture  for  producing  the  double  move- 
ment previously  described.  It  is  shown  in  position  in  Figs. 
90  and  91.  It  consists  of  two  flexible  metal  strips  attached 
to  and  held  apart  at  their  inner  ends  by  a  suitably-shaped 

*  Dental  Cosmos,  Vol.  XXXTV.,  p.  247. 


148 


ORTHODONTIA. 


wire  made  long  enough  to  rest  upon  the  palatal  surfaces  of 
the  two  teeth  bordering  the  space  to  be  occupied  by  the 
cuspid.  At  their  outer  extremities  these  metal  bands  were 
arranged  to  engage  with  a  curved  bolt  and  nut  overlying 


Fig.  90. 


Fig.  91. 


Fig,  92. 


Creating  Space  and  Moving  in  Cuspid.    (Matteson.) 

the  outstanding  cuspid  in  such  a  way  that  when  in  position, 
as  shown,  the  turning  of  the  nut  would  draw  the  ends  of  the 
strips  towards  one  another  and  thus  force  the  cuspid  inward 
at  the  same  time  that  the  adjoining  teeth  were  forced  apart 
to  provide  accommodation  for  it. 

Fig.  90  shows  the  appliance  as  first  used  and  Fig.  91  the 
same  with  a  longer  wire  substituted  for  the  shorter  one  after 

the  latter  was  rendered 
unserviceable  by  the 
moving  of  the  tooth. 

In  the  case  in  hand, 
after  the  preliminary 
wedging,  only  two 
weeks'  time  was  con- 
sumed in  bringing  the 
cuspid  into  place  with 
the  appliance,  as  de- 
scribed, although  the 
patient  was  a  well- 
developed  man,  twenty-two  years  of  age. 


Retainer.    (Matteson.^ 


PRACTICAL    TREATMENT. 


149 


The  tooth  was  retained  in  place  by  means  of  a  tubed  band 
cemented  to  it  with  wire  inserted  to  rest  against  adjoining 
teeth,  as  shown  in  Fig.  92. 

When  a  superior  cuspid  erupts  inside  of  the  arch  the  dif- 
ficulties attending  its  being  brought  into  position  are  far 
greater  than  when  it  erupts  externally..  This  is  partly  due 
to  the  fact  that  the  space  between  it  and  the  opposite  side  of 
the  arch  is  too  limited  to  admit  of  the  use  of  some  of  our 
best  power-yielding  appliances  and  parti}'',  also,  to  the  thick- 
ness of  the  alveolar  process  in  which  it  is  embedded  and 
that  will  have  to  be  resorbed  before  the  tooth  can  assume  its 
proper  position. 

The  power  to  be  applied  to  an  in-lying  cuspid  must  neces- 
sarily be  very  great  to  carr}^  with  it  any  prospect  of  success. 
A  solid  Coffin  plate,  with  a  very  stiff  piano-wire  embedded 
in  it,  will  yield  the  greatest  amount  of  spring  power,  but 
where  this  is  insuffi- 
cient we  must  needs 
resort  to  the  jack- 
screw  in  some-  of  its 
forms. 

An  appliance  of 
Dr.  Angle's,  as  shown 
in  Fig.  93,  for  forcing 
outward  a  cuspid  is 
neat,  simple  and  ef- 
fective. 

"  The    base    of     the  Jack-Screw  Moving  Out  Cuspid.    (Angle.) 

jack-screw  is  soldered  to  a  band  encircling  the  opposite  cus- 
pid and  reinforced  by  a  spur  resting  against  the  first  bicus- 
pid, and  also  by  the  large  traction  screw  which  is  hooked 
into  a  pipe  soldered  to  the  labial  surface  of  the  band  and 
passing  in  front  of  the  incisors  through  a  tube  soldered  to  a 
band  on  the  labial  surface  of  the  lateral  incisor,  against 
which  the  nut  works. 


150  ORTHODONTIA. 

"  In  this  case,  the  left  central  and  lateral  were  moved  for- 
ward in  the  line  of  the  arch,  thereby  closing  the  space 
between  the  centrals,  and,  at  the  same  time,  providing  space 
for  the  out-moving  cuspid.  The  large  screw  was  beaten 
flat  and  polished  before  insertion." 


CHAPTER  Y. 

MISPLACED    BICUSPIDS. 

The  bicuspid  teeth,  both  superior  and  inferior,  are  often 
found  located  outside  or  inside  of  the  normal  arcli  line,  but 
their  nial-position  is  not  of  as  frequent  occurrence  as  that  of 
the  anterior  teeth. 

Their  position  out  of  line,  as  in  the  case  of  most  forms  of 
individual  irregularity,  is  due  to  lack  of  space  or  the  crowd- 
ing of  other  teeth.  Sometimes,  through  tardy  eruption,  their 
space  in  the  arch  has  been  encroached  upon  by  the  pressure 
of  the  erupting  cuspids  in  front,  as  well  as  the  forward-moving 
tendency  of  the  molars.  In  such  cases  one  or  both  of  the 
bicuspids  are  compelled  to  assume  a  position  outside  or 
inside  of  the  arch,  the  latter  being  the  one  they  most  com- 
monly take. 

Again,  their  predecessors,  the  deciduous  molars,  frequently 
have  their  crowns  destroyed  by  caries  long  before  the  time 
for  their  natural  removal,  while  their  roots  remain.  Induce- 
ment is  thus  offered  for  the  adjoining  teeth  to  occupy  part  of 
the  space,  and  the  bicuspids  are  forced  to  erupt  in  an  abnor- 
mal position. 

In  other  cases,  they  may  have  taken  their  places  in  line, 
or  nearly  so,  and  are  subsequently  forced  out  of  place  by  the 
effort  of  the  cuspids  to  occupy  their  places  in  the  arch.  The 
ease  with  which  they  may  be  forced  out  of  position  is  readily 
understood  when  we  consider  that  their  roots  are  conical  and 
rather  short,  and  that  they  are  placed , between  teeth  that  are 
firmly  set  and  have  either  a  single  long  root  firmly  implanted, 
like  the  cuspids,  or,  several  roots,  like  the  molars.     Their  dis- 

151 


152  ORTHODONTIA. 

tinctly  convex  approximal  surfaces  also  greatly  favor  their 
displacement. 

The  second  bicuspid  is  more  frequently  found  out  of  line 
than  the  first,  probably  because  of  its  later  eruption. 

The  lack  of  alignment  of  one  or  both  bicuspids  is  some- 
times associated  with  a  greater  or  less  degree  of  torsion  ;  but 
this  is  not  of  common  occurrence,  and  when  met  with  is 
either  corrected  in  the  act  of  bringing  the  tooth  into  line  or 
will  have  to  be  remedied  by  a  separate  operation  afterward. 

The  greater  or  less  difficulty  of  bringing  into  line  one  or 
more  bicuspids  situated  inside  of  the  arch,  will  usually  be 
entirely  dependent  ajDon  the  amount  of  space  existing  for 
their  accommodation.  If  much  of  their  space  in  the  arch 
has  been  pre-occupied  by  adjacent  teeth,  these  will  first  have 
to  be  pressed  apart  to  afford  accommodation.  Should  full 
or  nearly  full  space  exist  for  them  in  the  arch,  they  may 
usually  be  forced  into  line  by  the  elasticity  of  a  vulcanite 
plate,  or  of  metal  in  some  form  of  spring.  Where  it  is  de- 
signed that  the  moving  tooth  shall  make  room  for  itself 
as  it  advances,  the  greater  power  of  the  jack-screw  will  be 
required. 

A  simple  method  of  moving  a  bicuspid,  either  upper  or 
lower,  outward  into  line  is  to  obtain  a  plaster  model  of  the 
jaw.  The  plaster  tooth  representing  the  one  to  be  moved 
should  then  be  cut  away  on  its  palatine  or  lingual  surface 
until  this  portion  of  it  is  in  line  with  the  same  surfaces  of 
the  adjoining  teeth.  A  vulcanite  plate  made  upon  this 
model  with  a  piece  of  piano- wire  embedded  in  its  central 
portion,  if  it  be  for  the  lower  jaw,  will,  by  its  elasticity,  soon 
bring  the  tooth  into  position.  Or,  we  may  make  the  plate 
upon  the  unaltered  model  and  then  insert  a  wooden  peg  in 
a  hole  drilled  in  the  plate  opposite  the  tooth  to  be  operated 
upon.  Or,  instead  of  the  wooden  peg,  a  metal  screw  may  be 
inserted  so  as  to  act  upon  the  tooth.  By  setting  the  screw 
well  into  the  rubber  plate,  it  may  be  elongated  by  unscrew- 
ing from  time  to  time  until  the  object  is  attained. 


PRACTICAL    TRICATMENT. 


153 


Fig.  94. 


Talbot  s  Vulcanite  Plate  and  (  oiled  spunt 


Fig.  95. 


Dr.  Talbot  lias  devised  an  excellent  method  of  forcing  one 
or  more  bicuspids  into  line  by  means  of  a  coiled  spring  of 

piano-wire,  in  connec- 
tion with  a  rubber  plate 
to  hold  it  in  position 
and  properly  direct  its 
action.  Fig.  94  repre- 
sents the  appliance  in 
position.  Dr.  Talbot 
says :  *  "A  thin,  narrow, 
close-fitting,  vulcanite 
plate  w^as  made,  and  a 
hole  drilled  through  the 
middle  of  it  opposite  the  centre  of  the  tooth  to  be  moved. 
In  the  other  side,  another  hole  was  drilled,  but  not  quite 

through  the  plate.  A  suitaljle 
spring.  Fig.  95,  was  then  made  of 
piano- wire,  having  a  single  coil  A, 
and  the  ends  of  its  arms  bent  at 
about  a  right  angle.  One  of  these 
ends,  C,  was  cut  short  to  enter  the 
corresponding  hole  in  the  plate,  and  the  other  end,  B,  left 
long  enough  to  go  through  the  plate  and  impinge  on  the 
lingual  surface  of  the  bicuspid,  leaving  a  full  eighth  of  an 
inch  between  that  arm  of  the  spring  and  the  plate,  as  is 
clearly  shown  by  Fig.  94,  where  the  spring  is  in  position  to 

act  upon  the  tooth  to  be  moved. 
Both  the  spring  and  the  plate 
may  be  removed  instantly,  either 
for  cleasing  purposes  or  to  increase 
the  power  of  the  spring  by  spread- 
ing its  arms,  or  to  open  the  coil  so 
that  the  tooth  may  be  held  steady  at  the  point  to  which  it. 
has  been  moved.      Fig.   96   shows   a   spring   having   two 


Coiled  Spring. 


Fig.  96. 
A 


Coiled  Spring. 


Dental  Cosmos,  Vol.  XXVIII.,  pp.  286-7. 


154  ORTHODONTIA. 

long  ends,  B  B,  which  is  designed  for  a  case  in  which  two 
.such  teeth  are  to  be  moved  in  opposite  directions." 

The  advantage  of  this  appliance  is  that  it  operates  with- 
out occupying  any  of  the  space  between  the  teeth,  which  in 
most  cases  is  important. 

Where  there  is  no  great  crowding,  however,  Magill  bands 
may  be  attached  to  the  anchor  tooth  or  teeth  and  the  one  to 
be  moved,  and  the  Talbot  spring  made  to  rest  in  suitable  de- 
pressions formed  in  them.  In  this  way  the  objection  to  a 
removable  rubber  plate  may  be  done  away  with. 

Where  the  superior  power  of  the  jack-screw  is  to  be  taken 
advantage  of,  Dr.  Kingsley's  method  of  using  it  in  combina- 
tion with  a  slotted  vulcanite  plate  is  one  of  the  best. 

The  accompanying  illustrations.  Figs.  97  and  98,  copied 

Fig.  98. 
Fig.  97. 

r 


Kingsley's  Slotted  Vulcanite  Plates  with  Jack-Screw. 

from  Dr.  Kingsley's  work,*  represent  some  of  the  ways  in 
which  he  accomplishes  movements,  slightly  varying  in  char- 
-acter.  Fig.  97  operated  to  move  outward  both  bicuspids  of 
the  left  side  inferior,  the  first  more  than  the  second  ;  while 
Fig.  98  moved  all  four  of  the  inferior  bicuspids. 

Where  it  is  desired  to  avoid  the  use  of  a  plate,  Magill 
bands,  re-enforced,  drilled  and  counter-sunk,  may  be 
cemented  to  the  teeth  to  be  moved  and  the  jack-screw  in- 
serted between  them.  Prof.  Angle's  device  for  expanding 
the  arch,  as  shown  and  described  on  page  106,  may  also  be 

*Loc.  cit. 


I'RAOTICAL  TREATMENT. 


155 


advantageously  used  for  moving  outward  one  or  more  of  the 
bicuspids.  It  will  be  noticed  that  in  the  operation  of  this 
appliance  any  instanding  teeth  are  moved  outward  into  line 
before  real  expansion  of  the  arch  begins;  if,  therefore,  the 
moving  of  individual  teeth  is  alone  desired,  operations  can 
be  suspended  as  soon  as  that  object  has  been  accomplished. 
The  small  size  of  the  jack-screw  in  the  Angle  device  is 
also  an  element  in  its  favor,  since  it  will  interfere  less  with 
the  movements  of  the  tongue  than  the  larger  ones  commonly 
used.  ^ 

In  addition  to  the  power  of  the  jack-screw,  it  has  the 
further  advantage  of  rapidity  of  action ;  so  that,  if  its  i)Osi- 
tion  in  the  mouth  should  somewhat  inconvenience  the 
patient,  it  would  do  so  only  for  a  very  short  time. 

Dr.  Jackson  lias    very    ingeniously  adapted  his    spring 

and  crib  method 
to  the  moving  of 
bicuspid.s,  as  shown 
in  the  following 
illustrations : — 

Fig.     99     illus- 
trates his  appli- 
ance   for    moving 
outward    two  first 
bicuspids. 
s^         *  "  A  base   wire 
I      is    shaped   to   the 
'  1    lingual  side  of  the 
anterior  teeth  and 
anchored     to    the 


Fig.  99. 


Spring  and  Crib  Appliance.     (Jackson.) 


bicuspids  by  means  of  single  crib  appliances.  To  each  of 
these  latter  is  attached  a  hook  or  eyelet  to  sustain  a  straight 
bar  of  spring  wire  that  is  sprung  over  the  anterior  teeth." 
By  this  means  the  bicuspids  may  be  moved  outward  and 
the  arch  flattened  in  front  at  the  same  time  when  desired. 

*  Denial  Cosmos,  Vol.  XXXIII.,  p.  1077  et  seq. 


156 


ORTHODONTIA. 


Fig.  100. 


For  moving  the  bicuspids  inward,  he  employs  a  device 
like  that  shown  in  Fig.  100. 

"  Thin  metal  is  fitted  to  the  labial  surfaces  of  the  teeth  to 
be  moved,  being 
made  to  extend  well 
towards  the  necks 
and  distal  surfaces  of 
the  teeth.  A  good- 
sized  spring  wire  is 
then  formed  to  fol- 
low the  outline  of  the 
anterior  teeth  on  their 
labial  surfaces  and 
extend  to  the  metal 
clasps,  to  which  it  is 

soldered.  Moving  Bicuspids  Inward.     (Jackson.) 

"  The  appliance  should  be  removed  from  time  to  time  and 
the  clasping  ends  of  the  spring  bent  toward  each  other  to 
exert  the  pressure  required." 

A  simple  wire  fixture,  by  the  same  writer,  for  moving 
either  outward  or  inward  a  single  bi- 
cuspid is  shown  in  Fig.  101. 

"A  spring  wire  is  bent  in  the  form  of  a 
crib  surrounding  the  misplaced  tooth 
and  an  adjoining  one  on  each  side,  pass- 
ing well  up  toward  the  gum  on  the 
labial  and  lingual  sides,  with  the  ends 
of  the  spring  wire  terminating  and 
overlapping     upon    the    tooth    to    be 

moved.  simple  wire  Spnng  (Jackson.) 

"  The  elasticity  of  'the  spring  will  exert  the  necessary 
force  to  move  the  tooth." 


Fig.  101. 


CHAPTER  VI. 

TORSION. 

The  term  torsion,  as  applied  to  the  teeth,  signifies  that 
condition  in  whicli  a  tootli  is  found  to  be  turned  upon  its 
axis.  Rotation  refers  to  tlie  act  of  twisting  or  turning  a 
tooth  so  as  to  bring  it  into  normal  position.  Torsion,  there- 
fore, describes  the  condition,  and  rotation  the  operation. 

Torsion  is  usually  due  to  some  abnormal  influence  opera- 
tive before  or  during  eruption.  Lack  of  space  will  often 
impel  a  tooth  during  eruption  to  turn  in  such  a  way  as  to 
present  its  smaller  diameter  toward  the  space  intended  for 
its  accommodation,  in  order  to  occupy  that  space  at  all.  A 
root,  or  even  a  portion  of  one,  will  also  often  cause  a  tooth 
to  partly  turn  in  its  socket  while  seeking  its  position  in  the 
arch.  Torsion  of  the  superior  central  incisors,  so  often  met 
with,  is  doubtless  due  in  the  majority  of  cases  to  undue 
thickness  of  the  median  alveolar  septum.  The  condition  is 
also  produced  after  eruption  by  the  crowding  of  adjoining 
teeth,  induced  by  some  unusual  pressure,  such  as  the  effort 
of  a  later  erupting  tootli  to  occupy  its  place  in  the  arch. 

Torsion  is  met  with  in  all  degrees  of  extent,  from  the 
slightest  prominence  of  one  corner  of  a  tooth  to  a  complete 
half- turn. 

It  occurs  generally  in  single-rooted  teeth,  or  in  those  with 
a  slightly  bifurcated  root ;  and  among  these,  those  with  roots 
most  nearly  round  are  the  ones  commonly  affected  on 
account  of  the  ease  with  which  they  can  be  made  to  turn 
upon  their  axes. 

At  times  cases  are  met  with  in  which  two  adjoining  teeth 
are  thus  affected,  usually  each  in  like  degree,  this  variety  of 
the  condition  being  known  as  Double  Torsion. 

157 


158  ORTHODONTIA. 

Rotation  is  usually  not  a  very  difficult  operation  in  itself, 
but  when  complicated  by  the  crowding  or  disarrangement 
of  adjoining  teeth  it  sometimes  proves  quite  troublesome. 

Where  there  is  sufficient  space  in  the  arch  to  accommodate 
the  tooth  after  it  has  been  turned,  we  have  simply  the  mat- 
ter of  rotation  to  deal  with ;  but  when  such  is  not  the  case, 
our  first  efforts  must  be  directed  toward  providing  space. 
This  may  be  done,  if  the  deficiency  be  slight,  by  pressing 
apart  the  impinging  teeth  by  some  of  the  means  described 
on  page  132  ;  but  where  great  space  needs  to  be  provided,  and 
expansion  of  the  arch  is  not  indicated,  it  will  be  necessary 
to  extract  some  less  important  tooth  to  afford  opportunity 
for  bringing  the  turned  tooth  into  line.  In  the  case  of  teeth 
with  flat  crowns,  as  the  incisors,  we  may  adopt  either  of  two 
plans  for  turning  the  tooth,  viz. :  grasping  the  crown  through- 
out its  entire  circumference  and  applying  suitable  power,  or 
by  direct  pressure  upon  one  or  both  of  the  angles  that  are 
out  of  line.  With  teeth  having  round  crowns,  such  as  the 
cuspids,  we  are  limited  to  the  plan  of  making  attachment  to 
the  periphery  of  the  crown. 

At  one  time  it  was  difficult,  if  not  almost  impossible,  to 
grasp  a  tooth  so  securely  as  to  have  the  attachment  resist  the 
strain  of  the  applied  power,  but  since  the  introduction  of 
the  Magill  band  this  greatest  of  all  difficulties  associated 
with  rotation  has  been  overcome. 

One  of  the  simplest  and  most  effectual  methods  of  rota- 
ting a  flat-crowned  tooth  is  by  the  use  of  a  rubber  plate 
made  to  cover  the  palate  and  envelope  the  posterior  teeth  on 
either  side,  according  to  the  Coffin  plan.  To  the  palatine 
portion  of  the  plate  a  piano-wire  is  attached  so  as  to  bear 
upon  the  inner  corner  of  the  tooth  to  be  turned,  while  a 
similar  wire  embedded  in  the  buccal  portion  of  the  plate  is 
arranged  to  press  upon  the  corner  that  projects.  The  bend- 
ing of  the  wires  from  time  to  time,  to  increase  the  tension, 
will  speedily  accomplish  the  desired  result. 

Where  only  one  corner  of  a  tooth  stands  out  of  line,  the 


PRACTICAL    TREATMENT.  159 

plate  just  described  may  be  modified  by  having  but  a  single 
wire  to  press  inward  the  outstanding  corner,  and  allowing 
the  rubber  plate  to  rest  firmly  against  the  corner  that  is  in 
line,  to  prevent  it  from  turning. 

Opportunity  for  the  projecting  portion  of  the  tooth  to 
move  inward,  must,  of  course,  be  provided  by  cutting  away 
the  rubber  plate  at  this  point. 

Another  way  of  rotating  a  tootli,  is  to  fit  a  band  or  ferrule 

of  gold  or  platinum  to  it,  with  a  headed  platinum  tooth-pin 

soldered  to  its  labial  face  near  the  angle  that  is  out  of  line. 

A  delicate  vulcanite  plate  is  then  made  to  fit  the  roof  of  the 

mouth,  and  into  it  at  a  suitable  point  is  screwed  a  threaded 

gold  wire  with  a  slight  curve  or  hook  on  its  end.     After  the 

band  is  cemented  to  the  tooth,  it  is  connected  with  the  gold 

hook  in  the  plate  by  means  of  a  rubber  ring.     Should  it  be 

desirable  to  change  the  point  of  attachment  on  the  plate,  it 

can  be  done  by  drilling  a  new  hole  at  the  desired  point,  and 

screwing   a   hook  into  it.      The  plate  can  be  removed  for 

cleansing  and  new  rubber  rings  applied  by  the  patient.    This 

plan  is  effective  in  cases  where  no  great  power  is  required. 

To   avoid   the   inconvenience   of  wearing  a 

Fig.  102.      plate  during  the  school-age,  the  author  many 

•^  years  ago  devised  a  small  and  inconspicuous 

V^*.^v^^^  appliance  for  rotating  a  single  incisor.     It  is 

The  Author's     shoWU     in     OUtlinC     in     Fig.     102,     and     is     con- 
Rotating  Device.      ,  ,     -1  n  n„„,„  . 

structed  as  toliow^s  : 
A  strip  of  platinized  gold  about  an  eighth  of  an  inch 
in  width,  and  gauge  No.  24  in  thickness,  is  bent  to  conform 
to  the  outline  that  we  wish  the  turned  tooth  and  its 
neighbor  to  describe  when  in  normal  position.  Each  end 
of  this  strip  is  bent  to  partly  encircle  the  disto-palatine  angle 
of  each  tooth,  after  which  another  strip  of  gold,  of  similar 
width  but  thinner,  is  soldered  to  the  centre  of  the  first  piece. 
This  last  piece  should  be  long  enough  to  extend  between 
the  teeth  and  embrace  the  protruding  edge  of  the  tooth  to  be 
turned. 


160 


ORTHODONTIA. 


By  bending  this  arm  so  short  that  the  appliance  will  have 
to  be  sprung  into  place,  pressure  is  brought  to  bear  upon  the 
tooth  that  will  cause  it  to  rotate  in  its  socket.  The  appliance 
should  be  removed  each  day,  the  length  of  the  arm  shortened 
by  bending,  and  replaced.  To  guard  against  loss  or  accident, 
a  ligature  of  sewing  silk  should  be  tied  around  the  neck  of 
one  of  the  teeth  and  made  fast  to  the  appliance.  About 
ten  d^js  will  usually  suffice  to  bring  the  tooth  into  proper 
position. 

The  tooth,  once  in  place,  is  readily  retained  by  means  of 

Fig.  103.  the  sniall  retainer  shown  in  Fig.  103.    In  its 

^-*''^^^'*«^      construction,  similar  bands  are  made  to  fit 

TT"*^   /^       both  the  corrected  tooth  and  its  neighbor, 

The  Author's  ^  _    .  o  ' 

Retaining  Fixture,  after  which  they  are  joined  by  solder  at  the 
point  where  they  touched  when  in  place.  To  add  stiffness, 
another  strip  of  gold  should  be  soldered  to  the  palatine  sur- 
face of  the  fixture.  When  completed  and  polished,  it  is 
lined  with  phosphate  of  zinc  and  placed  in  position  upon 
the  teeth. 

By  the  use  of  this  retainer,  which  occupies  but  little  space, 
the  tooth  is  held  so  rigid  in  its  new  position  that  it  becomes 
firm  much  more  rapidly  than  it  would  under  other  circum- 
stances. Should  the  force  exerted  by  the  effort  of  the  cor- 
rected tooth  to  return  to  its  former  malposition  be  so  great 
as  to  affect  the  tooth  used  as  anchorage,  this  tendency  may 
Pjq.  J04  be  prevented  by  soldering  a 

r     r^^G  spur  of  gold  to  the  appliance 

'  '^  at  a  suitable  point,  and  allow- 

ing this  to  rest  against  some 
firm  tooth  near  by. 

A  case  in  the  practice  of 
the  author  will  illustrate  a 
ready  means  of  correcting  an 

Torsion  Caused  toy  Supernumerary.  extreme  CaSC  of  torsiou.     The 

patient  was  a  Japanese  boy,  nine  years  of  age,  whose  upper 
denture  when  he  applied  for  treatment  presented  the  ap- 


PRACTICAL    TREATMENT. 


101 


Fig.  105. 


pearance  shown  in  Fig.  104.  The  left  deciduous  lateral  was 
still  in  place,  while  the  right  permanent  lateral  was  ju.st 
appearing  through  the  gum.  Both  permanent  centrals  were 
fully  erupted,  but  owing  to  the  presence  of  a  supernumerary 
tooth  in  the  centre  of  the  arch  the  right  central  was  crowded 
far  out  of  its  place  and  turned  upon  its  axis. 

After  extracting  the  supernumerary  and  the  deciduous 
lateral,  platinum  bands  were  fitted  to  the  centrals,  with  a  gold 
hook  soldered  to  each  at  points  tliat  would  furnish  the  great- 
est  amount   of   tractile  power. 
After  the  bands  were  cemented 
in    place   a   rubber    ring    was 
stretched  from  tooth  to  tooth,  in 
the  manner  shown  in  Fig.  105. 
The  malposed  tooth  was  thus 

Bands  and  Rubber  Ring  for  Rotation.  ti         i  x^j.      •     l  i.      j. 

readily  brought  into  contact 
with  its  fellow,  and  at  the  same  time  considerably  straight- 
ened. Its  further  and  complete  rotation  was  then  accom- 
plished by  an  appliance  somewhat  similar  to  that  shown  in 
Fig.  102,  after  which  it  was  retained  by  the  retainer  shown  in 
Fig.  103.  As  the  left  central  had  been  somewhat  loosened  in 
the  act  of  rotating  its  fellow,  it  was  found  necessary,  in  order 
to  secure  stable  anchorage,  to  attach  a  spur  to  the  appliance 
and  have  this  rest  against  the  palatine  surface  of  the  right 
Fig.  106.  lateral,  which  was  by  this  time 

almost  fully  erupted.  In  six 
months  the  teeth  were  firm  in 
their  new  position,  as  shown  in 
Fig.  106. 
A  simple  and  very  effectual 
method  of  accomplishing  the  rotation  of  any  tooth,  without 
regard  to  the  form  of  the  crown,  and  one,  too,  in  which  the 
use  of  a  plate  is  dispensed  with,  is  illustrated  in  Fig.  107. 

It  consists  of  a  platinum  or  gold  band  made  to  fit  the 
tooth  to  be  rotated,  and  having  an  extension  bar  of  heavy 
platinized  gold  soldered  to  its  labial  surface.     The  free  end 


Corrected  Case 


162 


ORTHODONTIA. 


of  the  bar  is  perforated  by  two  holes  for  hgation  to  some 
firm  tooth,  usually  a  molar.  In  use,  the  band  is  cemented 
to  the  tooth  and  the  bar  sprung  down  and  ligated  to  the  tooth 
selected  for  anchorage.  The  immense  leverage  of  this  bar 
will  quickly  compel  the  tooth  to  turn  in  its  socket.  As  its 
force    becomes    spent  Fig.  107. 

from  time  to  time  the  bar 
can  be  bent  outward 
with  pliers,  without  re- 
mo  v  i  n  g  it  from  the 
tooth.  After  the  tooth 
has  been  brought  into 
proper  alignment,  it  is 
most  conveniently  held 
in  position  by  means  of 

the     retainer    shown    in  spring  Bar  and  Band  for  Rotation. 

Fig.  17.  It  may  also  be  retained  by  a  rubber  plate  having 
a  gold  spur  to  pass  between  the  teeth  and  rest  upon  the  por- 
tion of  the  tooth  that  has  been  moved  inward. 

Prof.  Angle  has  improved  this  appliance  by  making  the 
band  and  bar  detachable. 

The  band  is  fitted  with  a  section  of  German  silver  tubing 
soldered  to  its  labial  surface,  parallel  with  the  cutting  edge 

of  the  tooth.     Another  band,  with  a 

hook  or  catch  soldered  to  its  buccal 

surf^ice,   is   fitted   to   a   bicuspid   or 

molar.     This  latter  band  also  has  a 

piece  of  tubing,  soldered  horizontally 

to  its  palatine  surface,  through  which 

is  passed  a  piece  of  wire  intended  to 

rest  against  the  two  teeth  adjacent  to 

the    one    banded    and   thus   afford 

Rotation.   (Angle.)         greater    resistance.      After   both    of 

these  bands  are  cemented  to  their  respective  teeth,  a  straight 

piece  of  piano-wire  is  inserted  in  the  tube  of  the  tooth  to  be 

turned,  and  bent  down  and  caught  in  the  catch  on  the  other 


Fig.  108. 


PRACTICAL    TREATM EXT. 


16H 


Fig.  109. 


tooth,  as  shown  in  Fig.  108.  The  advantage  of  this  modifi- 
cation is,  that  a  weaker  or  stronger  wire  can  be  substituted 
at  will,  and  the  power  be  thus  readily  controlled.  When 
the  tooth  is  in  proper  line,  the  wire  is  removed  and  replaced 
by  a  shorter  one  resting  upon  an  adjoining  tooth.  This  acts 
as  a  retainer  by  keeping  the  tooth  in  position  until  it  has 
grown  firm.  The  retaining  wire  is  secured  by  means  of  a 
pin,  inserted  in  a  hole  drilled  through  both  tube  and  wire. 
Another  simple  device  devised  by  Dr.  Jackson  *  for  rota- 
ting a  single  incisor  is 
illustrated  in  Fig.  109. 
It  consists  of  a  band  or 
collar,  made  to  encircle 
the  one  incisor,  to  which 
are  attached  upon  the 
labial  and  palatal  sur- 
faces two  lugs  to  receive 
a  U-shaped  wire.  One 
arm  of  this  wire  spring 
lies  upon  the  labial  side 

Rotating  Device.    (Jacksou.)  of    the     tCCth     and    prO- 

duces  pressure  upon  the  mesio-labial  corner  of  the  turned 
tooth  while  the  other  extends  along  the  palatal  surface  and 
presses  upon  the  disto-palatal  angle.  Pressure  in  opposite 
directions  is  thus  accomplished,  while  the  balancing  of  the 
two  forces  prevents  the  anchor  tooth  from  turning.  The 
appliance  is  too  small  to  in  any  way  interfere  with  speech  or 
occlusion. 

DOUBLE    TORSION. 

Where  two  adjoining  teeth,  as  the  superior  centrals,  are 
to  be  rotated  in  opposite  directions,  a  single  appliance  will 
often  accomplish  both  movements  at  the  same  time.  The 
appliance  devised  by  the  author  for  this  purpose  is  shown 


Denial  Cosmos,  Vol.  XXXIII.,  p.  1076. 


164  ORTHODONTIA. 

ill  Fig.  110,  and  the  details  of  construction  in  Fig.  111.     It 

is  a  modification  of  the  appliance  for  single  rotation  shown 

on  p.  159.     To  adapt  it  for  duty  in  turning  two  teeth,  instead 

F>  110         ^^  ^^^  single  strip  of  gold  passing  between 

the  teeth,  two  strips  are  bent  in  the  form  of 

"  b  "  and  "  c."     These  are  made  long  enough 

The  Author's  Device  to  be  bent  slightlv  over  the  labial  surfaces  of 

for  Double  Rotation.  ,  i  i 

the  teeth  to   be  turned,  extend   along  the 

Fig.  111.  mesial   surface    to   the   palatine,  and   then 

~\  r  along  this  latter  almost  to  the  distal  angle. 

^  Is^ After  being   properly  shaped  according  to 

<>k^...>ffys^,^       the  model,  they  are  clamped  together  and 
\i/  soldered    along   their    contiguous   surfaces. 

This  part  is  then  placed  in  position  on  the 
model,  and  the  long  arms  bent  to  conform  to  the  inner  sur- 
face of  the  bar  "  a,"  after  which  it  is  removed,  soldered  to 
"  a,"  and  the  part  "  b  "  "  c  "  reduced  in  thickness  by  filing, 
so  as  to  occupy  as  little  space  between  the  teeth  as  possible. 
When  properly  constructed  the  labial  part  of  the  appliance 
will  rest  against  the  teeth  just  at  or  slightly  above  the  most 
prominent  points  of  their  convexity,  while  the  lingual  por- 
tion will  be  near  the  gum,  but  not  quite  touching  it,  and  the 
slightly  curved  ends  of  this  part  will  catch  just  above  the 
little  prominence  usually  found  at  the  disto-palatine  angle 
near  the  gum. 

Thus  made  and  placed,  the  piece  cannot  become  displaced 
by  the  lip  or  tongue,  except  when  it  has  become  loosened 
by  the  moving  of  the  teeth.  As  will  readily  be  seen,  by 
its  use  force  is  brought  to  bear  upon  four  points  of  the 
two  teeth  at  one  time,  acting  as  a  double  lever  upon  each 
tooth. 

A  valuable  feature  of  the  appliance,  had  in  view  in  its 
devising,  is  that  it  occupies  but  one  interdental  space,  and 
thus  more  readily  favors  the  turning  of  teeth  that  are  more 
or  less  crowded. 

In  use,  the  patient  should  be  seen  each  day,  the  fixture 


PRACTICAL    TREATMENT. 


165 


removed  and  tightened  by  bending  tlie  long  arms  slightly 
toward  the  smaller  ones  and  sprung  into  place. 

To  facilitate  its  introduction  in  the  first  instance,  a  piece 
of  rubber  should  be  placed  between  the  teeth  one  day  pre- 
vious to  the  insertion  of  the  appliance. 

As  in  the  case  of  the  appliance  for  single  rotation,  a  thread 
should  be  tied  around  one  of  the  teeth  and  attached  to  the 
front  bar  to  guard  against  the  swallowing  or  loss  of  the 
piece.  Fig.  112  represents  a  case  of  double  torsion  which  was 
corrected  in  ten  days'  time  by  the  use  of  the  appliance  just 
described,  the  patient  being  seen  every  day  ;  while  Fig.  113 
shows  the  completed  operation.     After  the  teeth  are  in  posi- 


FiG.  112. 


Fig.  113. 


Double  Rotation. 


INI  III!  'I I  11 II  Hi    |l|||||||ll||l| 

Corrected  Case. 


tion,  they  may  be  best  retained    by  means  of  the  retainer 
shown  on  p.  160. 

When  the  distal  corners  of  the  teeth  project  instead  of  the 
mesial,  the  appliance  described  is  rendered  equally  service- 
able by  reversing  its  position  and  placing  the  long  arm  on 
the  labial  surface.  Fig.  114  represents  a  case  of  this  char- 
acter, while  Fig.  115  shows  the  rubber  plate  with  gold  wire 
bow  that  was  used  to  retain  the  teeth  after  correction.  A 
simpler  and  better  method  of  retention  would  have  been  to 
use  the  appliance  shown  in  Fig.  103. 


166 


ORTHODONTIA. 


Prof.  Angle  has  devised  a  very  simple  and  effectual 
method  of  accomplishing  double  rotation  where  the  mesial 
angles  protrude.  Upon  each  of  the  teeth  to  be  rotated  he 
places  Magill  bands  with  tubes  soldered  to  their  labial  faces 
near  the  distal  angles.     One  tube  is  set  vertically  and  the 


Fig.  115. 


Torsion  of  Centrals,  witli  I)i--til  Angles 
Pointing  Outward. 


Ketainiiig  Plate  on  Corrected  Case. 


Fig.  116. 


Fig.  117. 


Angle's  Appliance  for 
Double  Rotation. 


other  horizontally.  A  short  piece 
of  piano  or  German  silver  wire, 
bent  to  a  right  angle  at  one  end, 
is  inserted  into  these  tubes  and 
rotation  is  effected  by  the  elas- 
ticit}''  of  the  wire. 

Two  views  of  the  appliance 
are  shown  in  Figs.  116  and  117. 

Once  in  position,  the  teeth 
are  retained  by  inserting  in  the 
tubes  a  suitably-shaped  piece  of 
non-elastic  ffold  wire. 


CHAPTER   VII. 


CONTRACTION    OF    TPIE    ARCH. 


A  contracted  arch  may  be  due  to  lack  of  development, 
caused  by  late  or  mal-eruption  of  some  of  the  teeth  ;  to  the 
loss  of  certain  of  the  permanent  teeth  soon  after  their  erup- 
tion;  or  to  malposition  of  the  teeth  in  the  opposite  jaw. 

The  late  eruption  of  tlie  superior  cuspid  teeth,  where  their 
spaces  have  been  pre6ccu})ied  by  teeth  anterior  and  pos- 
terior to  them,  is  perhaps  the  most  frequent  cause  of  this 
deformity. 

In  some  cases,  the  contraction  is  limited  to  the  molar  and 
bicuspid  region ;  in  others,  to  the  anterior  alone  ;  while  in 
others  still,  the  entire  arch  needs  expansion. 

The  enlargement  of  the  arch,  either  at  certain  points  or  in 
its  entirety,  may  be  accomplished  by  a  variety  of  methods. 

Where  lateral  expansion  is  desired,  it  may  usually  be 
brought  about  in  a  simple  manner  by  the  use  of  the  Coffin 
split-plate,  the  construction  and  operation  of  which  are 
described  on  p.  108. 

Another  form  of  appliance,  intended  to  accomplish  the 
same  purpose  and  constructed  of  piano-wire  and  vulcanite, 
has  been  devised  by  Dr.  Talbot,  and  is  illustrated  in  Figs. 
118  and  119. 

In  his  description,  he  says :  *  "A  (vulcanite)  plate  is  made 
to  fit  the  teeth  and  alveolar  process,  and  cut  away  so  that  the 
anterior  parts  extend  far  enough  forward  to  enclose  the 
teeth  to  be  moved.  A  piece  of  (piano)  wire  is  bent  into 
either  of  the  forms  shown  in  Fig.  119,  wherein  '  a '  is  the 
coil  and  fixed  point,  '  b  b '  movable  arms  extending  from 
'  a,'  and  '  c  c '  movable  arms  extending  from  '  b  b.'    Grooves 

*  Talbot's  Irregularities  of  the  Teeth.     P.  221,  2d  Ed. 
167 


168 


ORTHODONTIA. 


are  cut  into  the  anterior  and  posterior  parts  of  the  plate  to 
correspond   with   and   receive   the   points  '  b  b '  and  '  c  c' 


Talbot's  Appliance  for  Lateral  Expansion.  Talbot  Springs. 

Holes  are  drilled  at  these  points,  and  the  wires  tied  to  the 
rubber  plates.  In  order  that  the  anterior  teeth  may  be 
moved  with  the  greatest  force,  the  arms  are  so  adjusted  that 
the  greatest  pressure  is  exerted  on  the  anterior  parts  of  the 
plates.  This  appliance  is  readily  removed  for  cleansing,  and 
returned  to  place  by  the  patient." 

Fig.  120.  Prof.  Goddard  em- 

ploys the  T  a  l,b  o  t 
spring  for  lateral  ex- 
pansion, dispensing 
with  the  rubber  plate 
and  using  instead, 
band  and  bar  attach- 
ments to  the  teeth,  as 
shown  in  Fig.  120. 
The  cut  so  fully  illus- 
trates the  appliance 
that  very  little  ex- 
planation is  needed. 

Combination  Appliance  for  Expansion.  (Goddard.)  The    holcS    in    the 

bars  on  either  side  are  for  the  reception  of  the  coiled  spring 


PRACTICAL    TREATMENT. 


109 


FIG.  121. 


which  can  be  placed  either  forward  or  backward,  according 
as  one  part  calls  for  more  expansion  than  the  other.  After 
the  arch  has  been  widened,  the  bent  wire  "  c  "  is  substituted 
for  the  coiled  spring,  and  retains  the  advantage  gained. 
The  long  wire  "  a  "  "  b  "  is  intended  to  be  used  where  any 
of  the  incisor  teeth  need  to  be  moved  forward.  In  such 
case  its  ends  are  inserted  into  the  tubes  on  the  bicuspid 
bands  and  rubber  rings  are  passed  over  it  and  the  in-lying 
incisors.  To  prevent  the  ends  of  this  wire  from  slipping 
through  the  tubes  they  may  be  threaded  and  supplied  with 
a  nut,  as  shown  at  "  b,"  or  they  may  be  bent  to  a  bayonet- 
shape,  as  shown  at  "  a." 

A  very  similar  appliance  for  use  in  the  lower  arch,  also 

devised  by  Prof.  God- 
dard,  is  illustrated  in 
Fig.  121. 

In  this  case,  as  in  the 
other,  the  long  wire  was 
used  for  attachment  in 
drawing  forward  the  in- 
locked  laterals. 

Where  more  force  is 
required  than  can  be 
obtained  from  either  of  the  appliances  just  described,  it  can 
be  had  by  the  more  direct  power  of  the  jack-screw,  operat- 
ing upon  the  portions  of  a  rubber  plate  lying  next  to  the 
teeth  to  be  moved. 

Dr.  Kingsley's  neat  and  effective  appliances  of  this  char- 
acter are  shown  on  p.  154. 

The  use  of  the  jack-screw  in  the  lower  jaw  would  appear 
to  be  objectionable  on  account  of  its  being  in  the  way  of  the 
tongue,  but  experience  has  proven  that  this  objection  is,  in 
fact,  a  slight  one. 

The  use  of   the  screw   hastens  the  operation  and   thus 
lessens  the  period  of  inconvenience  in  any  given  case. 
When  expansion  of  the  anterior  portion  of  the  arch  is 


Expansion  of  Lower  Arch.     (Goddard.) 


170  ORTHODONTIA. 

■desired,  it  may  be  accomplished  by  means  of  one  of  the 
appliances  shown  on  pp.  134  and  135,  or  by  a  modification 
■of  the  Coffin  split  plate  devised  by  Prof.  Goddard.  The 
latter  is  shown  in  Fig.  122. 

As   will   be   seen,  there  are  two  corrugated  piano-wires 

attached  to  the  rubber  plate, 
one  on  each  side  near  the 
free  margins,  while  the  plate 
is  split  laterally  just  back  of 
the  incisor  teeth.  As  in  other 
split  plates  for  anterior  ex- 
pansion, this  plate  is  made  in 
one  piece  and  the  wires  ar- 
ranged so  that  their  anterior 
ends  are  embedded  in  the 
portion  to  be  detached,  while 
the  posterior  ends   are  fast- 

Goddard's  split  Vulcanite  Plate.  ^^^^^  ^^  ^j^^  ^^-^  ^^^^  ^^  ^^^ 

plate.  After  the  completion  of  the  plate  the  front  portion  is 
separated  by  means  of  a  jeweler's  saw,  and  pressure  is  pro- 
duced by  stretching  the  wires  from  time  to  time. 

The  anterior  portion  is  kept  down  to  its  place  by  being 
ligated  to  the  central  incisors.  In  using  this  form  of  plate 
the  author  has  found  it  more  convenient  to  hold  the  front 
portion  down  by  imbedding  in  the  plate  a  gold  spur,  to  pass 
between  the  centrals  in  the  free  space  near  the  gum.  He 
also  prefers  to  secure  the  main  portion  in  position  by  making 
the  plate  to  cover  and  grip  the  bicuspids  and  molars,  as  in  the 
Coffin  method,  instead  of  fastening  it  to  the  side  teeth  with 
ligatures.  The  appliance  is  admirably  adapted  to  the  pur- 
pose for  which  it  was  devised. 

Where  expansion  of  the  entire  arch  is  desired,  a  better 
plan,  in  most  cases,  is  to  accomplish  it  by  separate  opera- 
tions. Lateral  expansion,  for  instance,  can  be  accomplished 
first,  and  after  the  bicuspids  and  molars  have  been  brought 
into  proper  position,  they  may  be  retained  by  means  of  a 


PRACTICAL    TREATMENT.  171 

rubber  plate  covering  them.  This  plate  will  not  only  hold 
them  firmly,  but  serve  as  an  anchorage  to  which  other  fix- 
tures may  be  attached  for  the  expansion  of  the  anterior  por- 
tion of  the  arch,  as  in  the  Goddard  plan. 

The  details  of  a  case  of  general  expansion  of  the  superior 
arch,  may  be  of  interest  to  the  student. 

The  patient  was  a  boy  of  about  fifteen  years  of  age.  The 
inferior  arch  was  of  normal  size,  with  the  teeth  well 
arranged.  In  the  superior  arch,  all  of  the  teeth  except  the 
cuspids  articulated  inside  of  the  lower  ones,  giving  the 
patient  a  pinched  or  contracted  appearance  in  the  region  of 
the  upper  lip.  The  laterals  were  almost  in  contact  with  the 
first  bicuspids,  while  the  cuspids  had  fully  erupted  outside 
of  the  arch  and  were  overlying  the  laterals. 

Extraction  was  not  indicated,  for  all  of  the  teeth  were 
needed  to  fill  the  arch  after  its  expansion. 

By  means  of  a  Coffin  split-plate,  lateral  expansion  was 
accomplished  in  about  a  month,  so  that  the  bicuspids  and 
first  molar  on  each  side  occluded  normally  with  those 
below.  Next,  with  another  Coffin  solid  ,plate  encasing  the 
teeth  that  had  been  moved,  and  with  two  piano-wires 
attached,  the  laterals  were  pressed  forward  ;  after  which,  new 
rubber  was  added  to  the  plate  to  keep  these  teeth  in  position, 
and  the  wires  changed  to  press  the  centrals  forward  into  line 
with  the  laterals.  After  this  had  been  accomplished  there 
was  still  insufficient  space  for  the  accommodation  of  the 
cuspids,  and  as  the  incisors  were  already  so  far  forward  that 
pressure  could  not  advantageously  be  brought  to  bear  upon 
them  from  the  rear,  another  plan  for  increasing  the  cuspid 
space  was  decided  upon.  Magill  bands  were  made  to  fit  the 
laterals,  with  gold  spurs  extending  along  the  palatine  sur- 
faces of  the  centrals  to  insure  uniform  movement,  of  the 
four  incisors.  Platinum  bands  were  also  attached  to  the 
first  bicuspids.  All  of  these  bands  we  reenforced  with  an 
additional  piece  of  platinum  soldered  to  the  portion  next  to 
the   space.      Through  these  re"nforcements,  at   a])out   the 


172 


ORTHODONTIA. 


centre  of  the  tooth,  holes  were  drilled  entirely  through  the 
bands.  Piano-wire  was  next  bent  into  the  form  of  small 
U-shaped  springs  with  the  ends  at  right  angles,  similar  to 
Dr.  Talbot's  plan,  but  without  the  coil.  Grasping  these 
near  the  neck  with  a  pair  of  narrow-beaked  right-angle 
forceps  transversely  grooved  near  the  points  to  seize  the 
wire,  the  springs  were  placed  in  position  with  their  ends 
resting  in  the  holes  of  the  bands.  As,  from  time  to  time, 
the  force  of  these  springs  became  spent,  they  were  removed 
and  their  power  renewed  by  enlarging  their  curves.  Suffi- 
cient additional  space  having  been  gained  by  their  use,  the 
cuspids  were  forced  into  position  by  means  of  a  Coffin  plate 
with  wires  attached  to  the  buccal  surfaces,  extending  forward 
and  resting  upon  the  labial  surfaces  of  the  cuspids. 

The  appearance  of  the  arch  and  teeth  with  the  U-springs 
Fig.  123.  in    position,    is 

shown  in  Fig. 
123.  The  opera- 
tions were  not 
hurried,  and 
consumed  about 
one  year's  time. 
A  retaining 
plate  of  vulcan- 
ite covering  the 
roof    of    the 

Increasing  Space  t>y  Curved  Spring  and  Bands  m  0  U  t  h.       With 

gold  loops  attached  to  overlie  and  retain  the  cuspids,  was 
worn  for  nearly  a  year. 

Another  case,  differing  somewhat  from  the  one  just  given, 
was  that  of  a  young  girl  about  eleven  years  of  age,  whose 
superior  arch  did  not  need  lateral  expansion,  but  required 
anterior  enlargement  to  accommodate  the  in-coming  cuspids. 
False  occlusion  of  the  superior  incisors  also  needed  correc- 
tion. Fig.  124  represents  the  case  as  it  presented.  The 
superior  centrals  met  the  lower  ones  edge  to  edge,  while  the 


PRACTICAL    TREATMENT. 


173 


Fig.  124. 


superior  laterals  passed  inside  of  the  lower  ones.  Tiiere  was 
very  little  room  between  the  superior  laterals  and  first  bi- 
cuspids to  accommodate  the 
cuspids,  which,  slow  of  erup- 
tion, were  just  beginning  to 
make  their  appearance. 

The  treatment  required 
was  the  moving  of  the  lat- 
erals and  centrals  so  as  to 
overlap  the  lower  ones,  and 

Case  Requiring  Anterior  Expansion.         the  mOving  backward  of  the 

bicuspids  on  each  side  to  afford  space  for  the  cuspids.  The 
laterals  were  first  moved  forward  into  line  with  the  centrals, 
by  means  of  the  plate  shown  in  Fig.  125.  This  accom- 
plished, the  anterior  portion  of  the  arch  was  expanded  by 
means  of  a  Goddard  split-plate. 

A  plain  rubber  plate,  covering  the  arch  and  touching  each 
tooth,  was  next  made,  and  into  it  were  secured  on  either  side 
pieces  of  piano-wire  bent  to  right  angles  at  their  free  ends, 
the  bent  portions  being  arranged  to  rest  upon  and  press 
against  the  mesial  surfaces  of  the  first  bicuspids  to  force 
them  backward.  The  plate  fig.  125. 

having  been  trimmed  to 
admit  of  the  backward 
movement  of  the  bicus- 
pids, full  space  for  the 
cuspids  was  soon  gained. 

The  slow  eruption  of 
the  cuspids  required  a  re- 
taining plate  to  be  made, 
armed  with  gold  spurs  at 
suitable  points,  to  keep  the  regulated  teeth  in  their  new 
positions  and  await  the  full  eruption  of  the  cuspids. 

At  the  end  of  six  months  the  cuspids  had  assumed,  un- 
aided, their  proper  places  in  the  arch,  and  by  their  key-like 
position  preserved  the  arrangement  without  the  further  aid 
of  any  retentive  appliance. 


Cofan  Plate  for  Pressing  Laterals  Forward. 


174 


ORTHODONTIA. 


The  case  had  previously  been  in  the  hands  of  two  den- 
tists, who  began  operations  for  correction,  and  it  therefore 
became  necessary  for  the  author  to  carry  it  forward  to 
completion. 

Had  he  been  consulted  in  the  beginning,  he  would  have 
advised  non-interference  until  two  years  later  when  the 
cuspids  would  have  been  partially  erupted,  and  more  nearly 
ready  to  assume  their  places  in  the  arch,  as  soon  as  room 
was  provided. 

In  this  way  the  wearing  of  a  retaining  plate,  to  await  the 
full  eruption  of  the  cuspids,  would  have  been  avoided  and 
the  case  simplified. 

Prof.  Angle  has  devised  a  neat  and  effective  appliance, 
constructed  entirely  of  metal,  for  the  lateral  expansion  of 
the  arch,  as  shown  in  Fig.  126. 

Like  the  Jackson  appliances,  it  utilizes  the  principle    of 

the  Coffin  spring  without 
the  objectionable  features 
of  the  rubber  plate.  It 
can  be  used  in  either  the 
upper  or  lower  arch  and 
where  no  greater  power 
than  the  spring  affords  is 
needed,  will  prove  very 
efficient. 

As  seen   in   the   cut,  a 

rubber    ligature    may   be 

attached  to  the  centre  of 

the   spring   and   be    con- 

Laterai  Expansion.   (Angle)  nected  with  any  cross-bar 

appliance  upon  the  incisors  for  drawing  them  inward  when 

such  additional  movement  is  desired. 


Fig.  126. 


CHAPTER   VIII. 


PROTRUSION  OF    THE  UPPER    JAW. 

This  deformity,  so  frequently  met  with  in  our  day,  not 
only  destroys  all  harmony  of  expression,  but  so  strongly 
suggests  the  facial  characteristics  of  idiocy  as  to  be  particu- 
larly objectionable. 

Fig.  127  shows  the  relation  of  the  teeth  in  outline  and 
Fig.  128  the  facial  expression.  In  the  latter  will  be  noticed 
the  conspicuousness  of  the  superior  incisors  and  the  result- 
ant shortening  of  the  upper  lip. 


Fig.  127. 


Fig.  128. 


Superior  Protrusion.    (Case.) 

The  causes  tending  to  produce  this  condition,  have  been 

briefly  considered  on  pages  23  and  24. 

There  are  two  varieties  of  this  deformity : — 

1st.  Where  the  lower  teeth  are  in  line  forming  the  normal 

curve,  while  the  upper  ones  pass  over  and  beyond  them  so 

175 


176 


ORTHODONTIA. 


as  not  only  to  interfere  with  enunciation,  but  also  to  render 
them  almost  unserviceable  in  mastication.  This  form  is 
usually  attributable  to  inheritance ;  to  the  abnormal  size  of 
the  teeth  in  the  superior  arch ;  or  to  the  mechanical  influ- 
ence of  pressure  on  the  part  of  the  posterior  teeth.  It  is  the 
one  most  easily  corrected,  on  account  of  the  operations  being 
confined  to  a  single  arch. 

Snd.  Where  the  lower  incisors  are  flattened  in  outline  or 
introverted,  and  the  superior  ones  extend  so  far  forward  as 
to  leave  a  large  space  between  the  two  when  the  jaws  are 
closed.  In  this  case,  the  superior  protrusion  appears  to  be 
greater  than  it  really  is,  on  account  of  the  superior  and  in- 
FiG.  129.  ferior   teeth    inclining   in 

different  directions.  Where 
there  is  introversion  of  the 
inferior  incisors  we  gener- 
ally find  their  cutting 
edges  on  a  higher  plane 
than  that  of  the  neighbor- 
ing teeth. 

This     condition   is,     in 
most    cases,    due    to    the 

Deep  Underbite.    (Case.)  habit      of     thumb-SUcking, 

the  thumb  pressing  the  lower  ones  in  and  the  upper  ones  out 
at  the  same  time. 

The  relatively  greater  height  of  the  cutting  edges  of  the 
lower  incisors  causes  them,  in  most  cases,  either  to  occlude 
with  the  bases  of  the  crowns  of  the  superior  incisors,  or  to 
come  in  contact  with  the  soft  tissues  back  of  them,  as  shown 
in  Fig.  129.  This  condition  seriously  complicates  the  mat- 
ter of  correction,  for  it  interposes  an  obstacle  to  the  inward 
movement  of  the  superior  teeth  and  the  outward  movement 
of  the  inferior  ones. 

Where  the  protrusion  is  slight  and  the  teeth  are  in  con- 
tact, space  for  their  inward  movement  may  sometimes  be 
obtained   by  dressing   off  any  discoloration   or   superficial 


PRACTICAL    TREATMENT.  177 

decay  from  the  approximal  surfaces  of  the  six  anterior  teeth 
with  sand-paper  discs  or  emory-cloth  strips,  followed  by 
thorough  polishing. 

By  this  means  the  author  has,  in  a  few  instances,  materi- 
ally improved  the  patient's  expression,  without  loss  of  teeth 
or  injury  to  tooth-substance.  The  space  once  gained,  the 
teeth  can  easily  be  brought  inward  by  the  use  of  a  Coffin 
plate,  cut  away  posteriorly  to  the  incisors,  and  having  gold 
hooks  attached  to  the  anterior  portions  of  the  plate  on  the 
buccal  surface.  A  rubber  band  caught  over  the  hook  on 
one  side,  carried  along  the  labial  surfaces  of  the  anterior 
teeth  and  attached  to  the  hook  on  the  opposite  side,  will 
generally  provide  the  required  tension.  Small  double  hooks, 
made  from  half-round  gold  wire  and  hung  over  the  cutting 
edges  of  the  centrals,  will,  by  their  second  curves,  support 
the  rubber  band  in  proper  place  and  keep  it  from  resting 
upon  and  irritating  the  soft  tissues.  Other  simple  means 
for  effecting  the  same  result,  will  readily  suggest  themselves 
to  the  operator.  Where  the  protrusion  is  of  greater  extent 
and  the  teeth  are  in  contact,  it  will  be  necessary  in  most 
cases  to  sacrifice  a  bicuspid  or  molar  on  one  or  both  sides  of 
the  mouth  to  obtain  sufiicient  space  to  enable  the  anterior 
teeth  to  be  moved  backward  into  line. 

After  the  extraction  of  the  tooth  or  teeth  it  is  well  to  draw 
backward,  by  easy  stages,  the  teeth  on  either  side  anterior  to 
the  space,  to  and  including  the  cuspids.  The  subsequent 
drawing  in  of  the  four  incisors  will  then  be  a  comparatively 
easy  matter.  In  many  cases,  if  the  posterior  teeth  were 
used  as  anchorages  for  the  inward  movement  of  six  or  ten 
anterior  teeth,  they  would  be  more  likely  to  move  forward 
than  to  cause  the  anterior  ones  to  V^e  forced  backward,  on 
account  of  the  disparity  of  resistance. 

A  number  of  methods  for  moving  backward  the  cuspid 
and  bicuspid  teeth  are  described  on  pp.  141  and  143.  A 
simple  plan  for  drawing  in  the  four  superior  incisors,  is 
shown  in  Fig.  130.     Platinum  bands  are  fitted  to  the  lat- 


178 


ORTHODONTIA. 


Fig.  130. 


erals,  and  to  their  labial  portions  are  soldered  extensions  of 
gold,  to  cover  and  rest  upon  the  labial  surfaces  of  the  ad- 
joining centrals. 
A  plain  rubber 
plate  is  also  made 
to  cover  the  pala- 
tine arch,  with  a 
gold  hook  inserted 
in  its  centre.  The 
bands  being  ce- 
mented in  place, 
rubber  rings  are 
slipped  under' the 
extensions  and 
carried  to  a  point  between  the  centrals  and  laterals,  where 
they  are  drawn  in  and  over  the  gold  hook  in  the  plate.  By 
their  contraction,  all  four  of  the  incisors  are  drawn  inward 
while  but  two  of  them  are  banded. 

A  plan  differing  somewhat  from  the  one  just  described,  is 
that  of  Dr.  Kingsley's,  illustrated  in  Fig.  131.  The  band 
overlying  the    in- 


Author's  Device  for  Retracting  the  Superior  Incisors. 


Fig.  131. 


cisors  is  of  gold, 
and  has  hooks 
soldered  to  the 
upper  edge  to  pre- 
vent its  slipping 
up  to  the  gum.  It 
is  also  fitted  with 
a  thin  strip  of  gold 
to  pass  between  the 
centrals,  the  free 
end  of  which  is 
connected  with  the  centre  of  a  vulcanite  plate  by  means  of  a 
ring  cut  from  rubber  tubing.  This  rubber  ring  is  made  fast 
to  the  plate  either  by  a  ligature  or  by  slipping  it  into  a 
horse-shoe  slot  cut  in  the  plate  for  the  purpose. 


Kingsley's  Gold  Bar  and  Vulcanite  Plate  for  Retraction. 


PRACTICAL    TREATMENT. 


179 


In  many  cases  the  elasticity  of  rubVjer  does  not  provide 
sufficient  force  to  move  backward  the  anterior  teeth.  In 
such  event  advantage  may  be  taken  of  the  superior  power 
furnished  by  piano-wire.  An  excellent  plan  for  arranging 
and  anchoring  such  wires  is  furnished  by  Dr.  Wads- 
worth.*  The  appliance  is  constructed  after  the  method  of 
Dr.  Jackson,  and  is  illustrated  by  Fig.  132. 

In  his  description,  Dr.  W.  says : — 


Fig.  132. 


"  A  vulcanite  plate 
was  fitted  to  the  roof 
of  the  mouth,  and 
well  cut  away  from 
the  lingual  surfaces 
of  the  front  teeth. 
Piano-wire  springs  of 
No.  21  wire  were  vul- 
canized into  the  plate, 
passing  through  the 
spaces  made  by  the 
removal  of  the  first 
bicuspids,  and  follow- 
ing around  from  each  side  of  the  labial  surfaces  of  the 
cuspids  and  incisors  were  made  to  pass  each  other  at  the 
median  line.  These  springs  were  bent  to  give  the  required 
pressure  on  the  teeth  to  be  moved  and  the  pressure  in- 
creased by  bending  the  springs  from  time  to  time  as  the 
teeth  were  moved  inward.  The  appliance  w^as  held  in  posi- 
tion by  clasps  made  from  No.  20  j)iano-wire  fitting  the 
bicuspids  and  molars,  as  seen  in  cut. 

"  The  patient  was  seen  once  or  twice  each  week  to  increase 
the  pressure  as  required  and  the  deformity  entirely  corrected 
in  three  months  and  a  half.  The  appliance  was  worn  con- 
tinuously, could  easily  be  removed  for  cleansing  and 
replaced  by  the  patient,  and  caused  no  pain  or  incon- 
venience whatever." 


*  Dental  Cosmos,  Vol.  XXXIII.,  p.  30. 


180 


ORTHODONTIA. 


Fig.  133. 


The  direct  and  forcible  action  of  the  screw  may  be 
conveniently  brought  into  play  by  means  of  the  device 
shown  in  Fig.  133.  It  is  a  vulcanite  plate  covering  the  arch 
and  encasing  the  molars,  to  which  is  attached  a  half-round 
gold  wire  bent  to  a  curve  and  long  enough  to  extend  along 
the  outer  surfaces  of  the  teeth  from  molar  to  molar.  One 
end  of  this  curved  wire  is  permanently  attached  to  the  vul- 
canite plate  while  the  other  terminates  in  a  threaded  wire, 
which  engages 
with  a  gold  nut 
playing  in  a  slotted 
recess  of  the  plate 
on  the  opposite 
side.  Turning  the 
nut  shortens  the 
bar  and  draws  the 
teeth  inward. 

When  still 
greater  powder  is 
demanded,  as  in 
cases  where  it  is 
desired  to  draw  the  six  anterior  teeth  inward  by  one  opera- 
tion, or  where  the  incisors  do  not  yield  readily  to  any  power 
that  can  be  applied  within  the  mouth,  anchorage  for  resist- 
ance must  be  obtained  outside.  Dr.  Kingsley,  we  believe, 
was  the  first  to  suggest  and  utilize  the  back  of  the  head  as 
an  anchorage  for  appliances  intended  to  produce  movements 
of  the  teeth.  Illustrations  of  a  fixture  of  this  character  will 
be  found  in  his  work,  pp.  133  and  134. 

Dr.  Farrar  also  devised  an  apparatus  for  the  same  purpose, 
but  it  is  somewhat  complicated  in  its  construction  and  man- 
ner of  adjustment. 

One  of  the  simplest  devices  of  this  character,  is  that  of 
Prof.  C.  L.  Goddard.*     In  describing  the  construction  and 


Appliance  for  Retraction.    (Tomes.) 


*  Annual  of  the  Universal  Medical  Sciences,  for  1888,  Vol.  III.,  pp.  547- 
551.     F.  A.  Davis,  Philadelphia,  publisher. 


PRACTICAL    TREATMENT.  181 

use  of  his  aj^pliance,  he  says :  "  On  a  cast  of  the  sujjorior 
incisors  a  small  sheet  of  wax  was  placed,  covering  the  labial 
surfaces,  cutting  edges  and  part  of  the  lingual  surfaces.  In 
the  anterior  surface  of  this  wax  plate,  a  steel  wire  was 
embedded,  curved  to  conform  to  the  arch,  and  extending 
laterally  about  one  inch  and  a  half  on  each  side.  The  ends 
of  this  wire  were  bent  in  the  form  of  hooks.  The  wax  plate 
and  wire  were  then  embedded  in  a  flask  by  bending  the 
ends  of  the  wire  sufficiently  to  allow  them  accommodation 

inside  of  the  flask.     By 
^'''-  ^^^'  the     methods     usually 

employed  in  vulcanite 
work,  a  plate  was  thus 
made   of  black  rubber 

Goddard's  Steel  and  Vulcanite  Appliance  for  .  . 

Retraction.  With  the  Wire  attached, 

as  shown  in  Fig.  134. 

"  When  placed  on  the  patient's  teeth,  the  ends  of  the  wires 
projected  from  the  corners  of  the  mouth  on  each  side  far 
enough  to  permit  elastic  bands  to  connect  them  with  a  cloth 
cap  on  the  patient's  head  without  touching  the  cheeks. 

"  The  cap  was  so  shaped  that  the  elastic  could  be  attached 
to  it  in  two  places  on  each  side,  one  above  and  one  below  the 
ear,  by  means  of  dress  hooks  sewed  to  the  cap  at  these 
points.  Round  silk-covered  elastic  cord  was  used,  and  the 
direction  of  the  force  could  be  varied  by  using  a  greater 
number  of  strands  above  or  below  the  ear,  according  to  the 
requirements  of  the  case.  The  amount  of  force  was  easily 
varied  by  shortening  or  lengthening  these  cords.  Fig.  135 
shows  the  appliance  in  position. 

"  This  appliance  was  worn  at  night  only,  and  the  teeth 
were  soon  moved  back  to  the  desired  position.  The  inferior 
incisors  striking  the  bases  of  the  superior  ones,  were  moved 
backward  with  them.  After  the  teeth  were  in  proper  posi- 
tion, the  tension  of  the  elastic  cord  was  slightly  lessened  and 
the  appliance  worn  at  nights  for  a  few  months  as  a  retain- 
ing appliance,  until  the  teeth  became  firm. 


182 


ORTHODONTIA. 


"  The  greatest  usefulness  of  this  appliance  is  in  cases  where 
there  are  no  teeth  in  the  mouth  §ufficiently  firm  for  the 
anchorage  of  an  appliance  of  ordinary  form,  or  where  the 
teeth,  if  firm  enough,  are  of  such  shape  that  it  is  practically 
impossible  to  fasten  appliances  to  them." 

Fig.  135. 


Goddard  Appliance  in  Position. 

The  worst  case  of  superior  protrusion  the  author  ever  met 
with  was  corrected  by  the  use  of  an  appliance  diff'ering  from 
Prof.  Goddard's  only  in  certain  minor  particulars. 

The  patient  was  a  boy,  sixteen  years  of  age,  whose  supe- 
rior teeth  projected  beyond  the  lower  ones  at  least  three- 
quarters  of  an  inch.  The  inferior  incisors  were  relatively 
long,  and  their  cutting  edges,  in  occlusion,  embedded  them- 
selves in  the  soft  tissues  of  the  palate  quite  a  distance  inside 
of  the  superior  teeth.  Both  arches  were  wide  and  well- 
formed,  and  all  of  the  teeth  were  in  contact.  Fig.  136  shows 
the  relation  between  the  upper  and  lower  teeth  at  the  time 


PRACTICAL    TREATMENT. 


183 


Superior  Protrusion  caused  by  Thumb-Sucking. 


of  presentation  for  treatment.  All  of  the  teeth  being  equally 
good  the  first  bicuspids  were  removed  to  provide  space. 
An  appliance  of  vulcanite  and  wire,  similar  to  Prof. 
Goddard's,  was  then  made ;  the  wire,  after  it  was  properly 
fashioned,    being  ^^^^^^ 

nickel-plated  be- 
fore vulcanization. 
The  scull-cap,  in- 
stead of  cloth,  was 
made  in  skeleton 
form  of  inch-wide 
black  silk  ribbon, 
each  strip  being 
double  and  lightly 
stuffed  with  cotton  to  make  it  more  comfortable  for  the 
patient.  The  elastics  used  M^ere  the  ordinary  flat  and  wide 
rubber  bands,  cut  and  perforated  near  the  ends  to  engage 
with  the  hooks  on  the  cap.  The  teeth  being  large,  strong 
and  firmly  set,  especially  the  cuspids,  moved  slowly ; 
but  in  five  months'  time,  by  the  use  of  the  above  appliance 
alone,  the  teeth  were  moved  back  into  proper  position,  the 
cuspids  coming  into  close  contact  with  the  second  bicuspids. 
The  cutting  edges  of  the  lower  incisors  were  ground 
off  somewhat  to  enable  the  superior  ones  to  be  moved 
inward. 

The  boy  being  in  attendance  upon  school  at  the  time  of 
the  operation,  and  not  wishing  to  subject  himself  to  the  rid- 
icule of  his  schoolmates  that  the  wearing  of  such  a  con- 
spicuous appliance  would  surely  bring  upon  him,  an  accessory 
appliance  was  devised  for  him  to  wear  during  school  hours. 
It  consisted  of  a  thin  silver  saddle  covering  the  protruding 
centrals,  to  which,  on  the  labial  surface  near  the  termina- 
tions, were  soldered  two  platinum  headed  pins.  The  first 
molars  were  fitted  with  platinum  bands,  to  which  platinum 
hooks  were  also  attached  on  the  buccal  surface.     The  bands 


184 


OE.THODONTIA. 


were 
was 
Fig. 
In 


Fig.  137. 


cemented  to  their  respective  teeth,  while  the  saddle 
removable.  This  appliance,  in  position,  is  shown  in 
137. 

use,  the  saddle  was  placed  in  position  and  the  pins  upon 

it  and  the  molar 
bands  connected  by 
means  of  thin  rings 
cut  from  French  rub- 
ber tubing  of  small 
diameter.  This  fix- 
ture was  simply  in- 
tended to  retain,  dur- 
ing the  day,  the  pro- 
gress made  by  the 
more  powerful  appli- 
ance at  night.  It 
was  put  on  in  the 
morning  before  start- 
ing for  school,  and 
after  school  hours  was 
replaced  by  the  press- 
ure appliance,  which 
was  worn  until  morn- 


Day  Retaining  Appliance 


Fig.  138. 


Corrected  Case. 


mg. 

Both  appliances 
were  removable  for 
cleansing,  and  were 
readjusted  and  oper- 
ated by  the  patient  himself.  They  gave  him  no  pain  or 
inconvenience  to  speak  of,  and  required  very  little  oversight 
on  the  part  of  the  operator.  For  the  first  three  months  of 
retention  the  day  appliance  was  worn  both  day  and  night, 
and  for  the  succeeding  three  months  at  night  only.  Fig.  138 
shows  the  relation  of  the  teeth  after  the  operation  was 
completed.  • 


PRACTICAL    TREATMENT. 


185 


For  the  reduction  of  anterior  protrusion,  Prof.  Angle's 
appliance  as  shown  in  Fig.  139,  commends  itself  for  simplicity 
and  efficienc3^  It  consists  of  anchor  bands  (D)  for  the 
molar  teeth  with  long  tubes  soldered  to  their  buccal  surfaces 
to    receive 

the    wire  ^'^-  l^^- 

bow-spring 
(C)  which 
rests  in 
front  in 
notched  projec- 
tions upon  bands 
(A)  cemented  to 
the  central  in- 
cisors. At  the 
centre  of  the  bow- 
spring  is  soldered 
a  short  tube,  hav- 
ing upon  its  labial 
surface  a  rounded 
projection  to  re- 
ceive the  standard 
(cupped  at  its  free  end)  of  the  long  traction  bar  (E).  In 
use,  the  clamp-bands  (D)  are  attached  to  the  anchor  teeth 
and  the  plain  bands  (A)  cemented  to  the  central  incisors. 
The  bow-spring  (C)  is  now  placed  in  position. 

Occipital  resistance  is  obtained  by  means  of  a  netted  cap 
fastened  to  a  circle  of  wire  fitted  to  the  head,  to  which  are 
attached  rubber  bands.  When  the  cupped  standard  of  the 
traction  bar  has  been  placed  over  the  central  spur  of  the 
bow-spring,  the  rubber  bands  of  the  cap  are  drawn  forward 
and  looped  over  the  curved  ends  of  the  traction  bar,  as 
shown  in  Fig.  140.  This  cap,  traction  bar  and  rubber 
bands  are  worn  only  at  night  on  account  of  their  conspic- 
uousness. 

During  the  day,  rubber  rings  (B)  are  caught  over  the 


Angle's  Appliance  for  Reduction  of  Anterior  Protrusion. 


186 


ORTHODONTIA. 


Fig.  140. 


tubes  on  the  molar  bands  and  secured  by  ligature  to  projec- 
tions on  the  bow-spring  in  the  region  of  the  cuspid  teeth. 

The  appliance  in  po- 
sition, as  worn  dur- 
ing the  day,  is  illus- 
trated  by   Fig.    141. 
After    reduction    of 
anterior    protrusion 
we  are  met  with  the 
difficulty   of    retain- 
ing     the      results 
gained.       Although 
the    posterior   teeth 
in   many   cases   will 
not    furnish  the    re- 
sistance necessary  for 
drawing  the  anterior 
teeth    inward,    they 
will  usually   answer 
perfectly  for  re- 
taining    them 
afterward.     At- 
tachment can  be 
made    to    them 
either  by  means 
of  a  rubber  plate 
covering     the 
roof     of     the 
mouth  and  ex- 
tending around 
their  distal  sur- 
faces in  the  form 
of  a  clasp,  or  by 
means  of  metal 
bands  cemented  to  them.     In  the  former  case  a  small  round 


Night  Appliance.     (Angle.) 

Fig.  141. 


Day  Appliance.    (Angle.) 


PRACTICAL    TREATMENT.  187 

or  half  round  gold  wire  may  be  made  to  pass  around  the  arch, 
touching  the  regulated  teeth  on  their  labial  surfaces,  and  be 
attached  at  each  end  to  the  rubber  plate  at  convenient 
points,  as  where  teeth  have  been  extracted.  In  the  latter 
case  a  similar  retaining  wire  may  be  soldered  to  the  molar 
bands,  or  the  bands  may  have  tubes  soldered  to  their  buccal 
surfaces  and  the  wire,  threaded  at  the  extremities,  passed 
through  these  and  retained  by  means  of  nuts  operating 
upon  them.  In  either  case  the  retaining  wire  should  have 
short  gold  clips  attached  to  it  in  front  to  engage  with  the 
cutting  edges  of  at  least  two  of  the  incisor  teeth. 

Where  it  is  desired  to  avoid  having  a  retaining  wire  pass 
entirely  around  the  front  of  the  arch,  a  rubber  retaining 
plate  may  be  made  with  a  gold  T  passing  between  the 
centrals  and  long  enough  to  rest  upon  all  four  of  the  incisors. 
Holding  these  teeth  firmly  in  place  will  also  keep  the  cuspids 
in  line  through  lateral  pressure. 

In  all  cases  the  retaining  appliance  should  be  worn  for  a 
year  or  more,  until  we  are  fully  satisfied  that  the  teeth  are 
firm  in  their  new  positions  and  manifest  no  tendency  to 
change. 


CHAPTER  IX. 

PROTRUSION  OP  THE  LOWER  JAW,  OR  PROGNATHISM. 

This  condition,  one  of  the  most  unsightly  of  dental  deform- 
ities, giving  to  the  individual  a  rather  inhuman  expression 
and  interfering  greatly  with  speech  and  mastication,  is  quite 
frequently  met  with.  The  causes  probably  responsible  for 
its  inducement  are  given  on  p.  25. 

When  the  deformity  is  slight  it  may  be  corrected,  or  at 
least  modified,  by  pressing  the  lower  incisors  inward  and  the 
upper  ones  outward  ;  but  where  the  case  is  pronounced,  there 
seems  to  be  no  remedy  for  it  but  the  retraction  of  the  entire 
inferior  maxilla.  This  may  best  be  accomplished  by  using 
some  form  of  scull  cup,  and  connecting  it  with  a  padded 
chin  piece  by  means  of  strong  rubber  bands.  The  persist- 
ent contraction  of  the  rubber  will,  in  a  greater  or  less  time, 
dependent  largely  upon  the  extent  of  the  deformity  and  the 
age  of  the  patient,  bring  about  the  desired  change. 

In  the  accomplishment  of  this  retraction,  it  was  formerly 
supposed  to  be  brought  about  by  a  change  effected  at  the 
angle  of  the  jaw ;  but  the  more  j)lausible  hypothesis,  is  the 
one  first  advanced  by  Dr.  Geo.  S.  Allen,  namely :  That  the 
pressure  applied  to  the  mental  region  causes  resorption  of 
the  posterior  wall  of  the  glenoid  cavity,  thus  permitting  the 
condyles  to  recede  and  articulate  somewhat  posteriorly  to 
their  former  position.  This  theory  as  to  the  physiological 
change  brought  about,  is  supported  by  the  fact  that  an  alter- 
ation of  form  in  the  gleniod  cavity  is  more  readily  accom- 
plished by  resorption,  than  a  bending  of  the  maxilla  at  its 
strongest  point. 

An  interesting  case  of  retraction  of  the  lower  jaw,  was 
brought  before  the  Odontological  Society  of  New  York,  in 
1878,  by  Dr.  Allen.     I  quote  important  points   from   his 

188 


PRACTICAL    TREATMENT. 


189 


description :  "  As  will  be  seen  from  the  photograph  (Fig. 
142),  taken  at  the  time  she  was  wearing  this  apparatus,  it 
consists  of  two  parts.  For  the  lower  part,  I  made  a  brass 
plate  to  fit  the  chin,  having  arms  with  hooked  ends  reaching 
to  a  point  just  below  the  point  of  the  chin.  These  arms 
were  arranged  in  such  a  way,  that  the  distance  between  them 
could  be  altered  at  will,  by  simply  pressing  them  apart  or 
The  upper  part  consisted  of  a  simple   network, 


together 


Fig.  142. 


Allen's  Device  for  Retraction  of  Lower  Jaw. 


going  over  the  head  and  having  two  hooks  on  each  side,  one 
hook  being  above  and  the  other  below  the  ear.  When  this 
apparatus  was  completed  and  in  use,  there  were  four  liga- 
tures of  ordinary  elastic  rubber  pulling  in  such  a  way  as  to 
force  the  lower  jaw  almost  directly  backward.  The  work 
proceeded  very  rapidly,  so  that  at  the  end  of  two  months 
the  irregularity  was  almost  entirely  cured.  I  see  no  reason 
why,  in  all  such  ca.ses,  either  this  or  similar  methods  of  pro- 


190 


ORTHODONTIA. 


Fig.  143. 


Fig.  144. 


cedure  should  not  be  adpoted.  I  should  certainly,  if  any- 
similar  cases  presented  hereafter,  even  at  twelve  or  thirteen 
years  of  age,  before  attempting  any  other  procedure,  try  this 
first  and  thoroughly." 

In  forming  the  chin  piece  for  cases  of  this'  character  the 

author   is   accustomed   to 
take  a  plaster  impression 
of  the  chin  and  from  this 
make  a  model.  The  model 
is    then    overlaid   with  a 
piece    of  trial-plate   wax, 
from   which,   after    being 
varnished,  a  mould  in  sand 
is  obtained  and  a  die  and  . 
counterdie  made.    Be- 
tween these  a  piece  of  soft 
and  heavy  brass  plate 
is  s  t  r  u  c  k   up   and 
drilled  full  of  holes. 
After  fashioning 
heavy  piano  wires  to 
cross   the   plate  and 
extend  sufficiently 
beyond     to     form 
hooks,  they  are  soft- 
soldered  to  the  brass 
plate   and  the  latter 
covered  with  black 
silk    with    a   thick 
layer  of  cotton  b  a  t- 
ting  laid  between  the 

'  '^"^  two.     The  enlarged 

//■■I  .  r 

size  of  the  chin  piece 

will  admit  of  this.     The  piece  thus  padded  will  fit  the  chin 

and  be  soft  enough  to  prevent  pain  when  pressure  is  brought 

to  bear  upon  it. 


PRACTICAL    TREATMENT. 


191 


Fig.  145. 


A  chin-piece  devised  and  used  by  Dr.  Kingsley*  is  siiown 
in  Fig.  1 43.  It  is  made  of  "  sheet  copper  (stiffened  around 
the  edge  with  non-elastic  steel  wire  accurately  fitted  to  a 
plaster  cast  of  the  chin)  padded,  and  covered  with  leather." 
The  skeleton  skull-cap,  used  in  connection  with  the  chin 
appliance  by  Dr.  K.  is  made  of  leather  and  is  shown  in 
position  in  Fig.  144. 

The  Drs.  Winner,  of  Wilmington,  Del.,  have  furnished 
the  writer  with  models 
and  description  of  a 
case  somewhat  similar 
to  the  foregoing  (Figs. 
145  and  146).  In  their 
case,  the  patient  was  a 
boy  fourteen  years  of 
age,  tall,   slender,   i)OS- 

sessing  good  general- 

health,    but    only    fair 

physical  strength.    The 

models  show  that  there 

was  a  bicuspid  lacking 

on  each   side   above, 

while  below  there  still 

remained    two    tempo- 
rary molars.    He  stated 

that  he  had  never  had 

any  teeth  extracted  by 

a  dentist, so  it  is  probable 

that   the  two  bicuspids 

were  never  erupted. 

The    superior    centrals 

were  considerably  worn 

away  on  their   cutting 

edges    and   labial   sur- 
faces  by  attrition  with  the  lower  ones.     After  extracting 

*  Dental  Cosmos,  Vol.  XXXIV.,  p.  19. 


I'roErnathism. 


Fig.  146. 


Case  Corrected. 


192 


ORTHODONTIA. 


Fig.  147. 


the  deciduous  molars  below,  a  plate  was  made  covering  the 
upper  posterior  teeth,  and  so  arranged  that  in  addition  to 
furnishing  a  masticating  surface  while  the  teeth  were  apart, 
it  acted  as  an  inclined  plane  in  helping  the  lower  jaw 
to  move  backward.  From  first  to  last  he  wore  an  occipito- 
mental sling,  as  illustrated  in  Garretson's  Oral  Surgery,  in- 
creasing the  tension  from  slight  at  first  to  as  tight  as  could 
be  borne  without  too  great  discomfort.  At  the  end  of  nine 
weeks  the  articulation  was  normal,  but  the  sling  was  worn 
for  several  weeks  longer,  without  increased  tension,  to  retain 
the  satisfactory  result  secured.  There  can  be  no  doubt  that 
the  wearing  of  a  plate  in  tlie  upper  jaw  arranged  with  an 
inclined  plane,  as  described,  will  materially  assist  in  forcing 

the    lower   jaw 
backward. 

Fig.  147  illus- 
trates the  most 
f)ronounced 
case  of  this  class 
0  f  deformities 
the  writer  has 
ever  met  with. 
The  patient  was 
a  man  of  about 
forty  years  of 
age  and  was 
brought  by  a  neighboring  dentist  for  consultation  as  to 
whether  anything  could  be  done  to  remedy  the  defect.  The 
lower  jaw  was  very  large  in  all  its  aspects,  while  the  upper 
was  correspondingly  small.  Although  the  lower  incisors 
inclined  decidedly  inward,  the  distance  from  the  cutting 
edge  of  the  lower  incisors  to  the-  cutting  edge  of  the  upper 
in  a  horizontal  line,  was  a  little  over  half  an  inch.  From 
the  upper  jaw  there  were  missing  the  right  lateral,  second 
bicuspid  and  first  molar ;  while  on  the  left  side,  the  second 
bicuspid  and  two  molars  were  absent.     In  the  lower  jaw,  the 


Excessive  Prognathism. 


PRACTICAL    TREATMENT.  193 

patient  had  lost  two  molars  and  a  bicuspid  on  the  left  side, 
and  the  first  molar  on  the  right.  All  the  teeth  of  the  upper 
jaw  passed  inside  the  lower,  except  the  first  bicuspids,  whose 
external  cusps  articulated  slightly  with  the  anterior  lingual 
cusps  of  the  opposite  molars  below. 

The  advanced  age  of  the  patient,  conjoined  with  the  con- 
ditions just  described,  placed  his  case  beyond  surgical 
remedy  and  he  was  so  informed.  A  plate  covering  and 
masking  the  natural  teeth  above  with  artifical  teeth  mounted 
outside  to  articulate  with  the  lower  ones  was  suggested,  but 
the  idea  did  not  please  him,  and  he  concluded  to  pass  the 
remaining  portion  of  his  life  as  he  had  the  first,  so  far  as  his 
dental  apparatus  was  concerned. 


CHAPTER  X. 


LACK    OF    ANTERIOR    OCCLUSION. 


In  certain  rare  instances,  cases  are  met  with  in  which  the 
anterior  teeth  do  not  come  in  contact  upon  closure  of  the 
jaws.  The  bicuspids  and  molars  of  both  jaws  may  articu- 
late properly,  but  in  the  front  part  of  the  mouth  there  ex- 
ists a  space  more  or  less  great  between  the  cutting  edges  of 
the  incisors,  when  the  jaws  are  closed.  The  space  is  greatest 
at  the  median  line  and  gradually  diminishes  toward  the 
cuspids.  The  condition  not  only  gives  a  lisp  to  the  speech 
of  the  individual,  but  renders  these  teeth  entirely  useless  for 
purposes  of  mastication. 

At  first  glance  the  incisors  have  the  appearance  of  being 

too  short  in  their 
crowns,  but  an  exam- 
ination will  usually 
show  that  they  are 
of  normal  size  and 
length  and  that  the 
process  and  possibly 
the  maxilla  itself  is 
responsible 
shortened 


Fig.  148. 


Lack  of  Anterior  Occlusion. 


for    the 
appear- 
ance. 

In  most  cases  it 
will  be  found  that  both  arches  are  normal  in  form  and  size, 
that  there  is  no  antroversion  or  introversion  either  above  or 
below,  and  that  the  superior  teeth  alone  are  at  fault.  Fig.  148 
represents  a  typical  case  of  this  character,  the  model  being 
from  the  collection  of  Dr.  H.  A.  Baker. 

194 


PRACTICAL    TREATMENT.  195 

Fortunately,  the  condition  is  seldom  met  with,  for  it  is  the 
one  of  all  others  that  is  least  amenable  to  successful  treat- 
ment. 

The  cause  of  the  deformity  has  been  variously  attributed 
to  thumb-sucking,  to  sleeping  with  the  mouth  open  and  to 
derangement  of  the  articulation  caused  by  ill-advised  ex- 
traction of  some  of  the  posterior  teeth ;  but  while  all  of 
these  are  doubtless  responsible  for  the  condition  in  many 
instances,  it  is  probably  more  frequently  caused  either  by 
the  lack  of  alveolar  development  in  the  incisor  region,  or  an 
unaccountable  variation  in  the  j^lane  of  the  alveolar  border 
of  the  maxilla.  The  author  has  met  with  no  cases  of  this 
condition  that  bore  evidence  of  hereditary  transmission, 
and  therefore  believes  it  to  be  due  to  a  peculiarity  in  the 
development  of  the  maxilla,  originated  with  and  confined 
to  the  individual  himself. 

One  plan  of  treatment,  where  the  deformity  is  slight,  con- 
sists in  grinding  off  the  cusps  and  antagonizing  points  of 
some  or  all  of  the  posterior  teeth  in  order  to  shorten  the  bite 
and  bring  the  anterior  ones  more  nearly  together.  Much  of 
this  cannot  be  done  without  denuding  the  teeth  of  their 
enamel  at  certain  points  and  exposing  the  sensitive  dentine, 
but  by  grinding  as  much  as  is  possible  without  causing  too 
great  j)ain  and  then  administering  an  anaesthetic  and  con- 
tinuing the  grinding,  quite  an  improvement  can  be  brought 
about. 

The  sensitiveness  of  the  exposed  dentine  may  afterward 
be  obtunded  by  repeated  applications  of  either  chloride  of 
zinc,  caustic  potash  or  nitrate  of  silver.  Where  neither  of 
these  will  avail  sufficiently,  it  may  be  advisable  to  devital- 
ize two  or  more  of  the  teeth  most  interfering  with  occlusion 
and  then  continue  the  grinding  until  the  necessary  change 
is  effected.  The  devitalized  teeth  v/ill,  of  course,  have  to  be 
subsequently  treated  and  filled. 

This  method  seems  better  than  extraction  because  it 
leaves  a  portion  of  the  crown  for  necessary  mastication,  but 
in  some  cases  extraction  may  be  the  better  plan. 


196  ORTHODONTIA. 

Another  plan,  for  aggravated  cases,  is  to  produce  pressure 
upon  the  anterior  portion  of  the  lower  jaw  by  means  of  a 
skeleton  cap,  chin-piece  and  rubber  bands,  very  similar  to 
the  appliance  used  in  retraction  of  the  lower  jaw,  only  that 
in  the  present  case  the  power  should  be  applied  in  an  almost 
vertical  direction.  With  such  an  apparatus,  worn  continu- 
ously for  a  few  months,  the  condyles  of  the  lower  jaw  will 
be  tipped  somewhat  out  of  their  cavities  and  the  latter  be 
partially  filled  up  with  new  ossific  material;  at  the  same 
time  the  tendency  will  be  to  shorten  the  posterior  occluding 
teeth  by  forcing  them  farther  into  their  sockets  and  the  cor- 
rection in  this  way  be  incidentally  assisted. 


PART  lY. 

CHAPTER  I. 

CROWDED    LOWER    INCISORS. 

While  general  consideration  has  been  given  to  teeth 
erupting  or  situated  inside  or  outside  of  the  arch,  there  is 
one  condition  of  rather  common  occurrence  that  calls  for 
special  mention.  It  is  the  crowded  or  jumbled  condition  of 
the  inferior  incisors  after  dentition  is  complete. 

Fig.  149  shows  an  extreme  case  of  this  character. 

Fig.  149.  The   moving   of  a   single 

■""^  f^\       ^'^^^^  incisor  either  inward  or 

f        ^^  ^"''^^^lA     o^^^ward  into  hne  has  been 

^      '    ^  /       ,•     i^Q^i^^  of  in  Part  III.,  Chap- 

\    -^  L  "     Ym       ^^^'^  "'"■   ^"^^  ^^^''  ^^"^  where 

\  '^      y~  v_     ^^^W        several  or  all  of  these  teeth 

^'^^^^^^^^^^^^^  are  more  or  less  out  of  line 

and  possibly  turned  upon 
their  axes,  the  condition  becomes  a  somewhat  difficult  one 
to  treat  successfully. 

The  expanding  of  the  arch  to  permit  of  all  of  them  being- 
brought  properly  into  line  involves  an  operation  of  some 
magnitude,  and  is  likely,  in  many  cases,  to  disarrange  an 
otherwise  good  articulation.  For  these  reasons  expansion 
should  not  be  attempted  except  in  very  rare  cases,  where 
improvement  of  the  articulation  is  desired  and  can  be 
attained. 

Two  simple  methods  of  treating  these  cases  are  open 
to  us  : — 

First,  where  the  crowding  is  not  excessive,  each  of  the 

197 


198 


ORTHODONTIA. 


malposed  teeth  may  be  dressed  off  at  the  most  prominent 
points  of  their  approximal  surfaces  by  means  of  hard  rubber 
and  corundum  disks  or  by  the  more  flexible  emery-cloth 
disks,  and  by  thus  lessening  their  respective  diameters 
proper  accommodation  may  be  found  for  them  in  the  arch. 
Second,  where  the  teeth  are  very  much  crowded  out  of 
position  and  where  the  space  between  the  cuspids  is  entirely 
inadequate  for  their  accommodation  it  will  be  best  to  extract 
one  of  them  in  order  to  enable  the  remaining  three  to  be 
brought  into  place. 

As  mentioned  on  page  51,  the  best  tooth  to  extract  in  such 
cases  is  the  one  most  out  of  line,  or  the  one  in  such  position 
as  to  enable  the  remaining  ones  to  be  most  easily  moved 
into  proper  alignment. 

After  extraction,  means  will  have  to  be  adopted  to  draw 
the  teeth  into  position,  in  doing  which  the  space  created  by 
extraction  will  also  be  closed.  Perhaps  the  simplest  way  of 
drawing  the  teeth  together  is  by  the  use  of  a  rubber  ring 
slipped  over  the  teeth  and  kept  from  impinging  upon  the 
gum  by  a  silk  ligature  wound  several  times  around  the 
terminal  teeth  near  their  necks  and  then  tied  to  the  ring 
itself. 

After  the  teeth  are  drawn  together  and  the  space  closed, 

they  may  be  aligned  by  any  of 
the  appliances  illustrated  for  mov- 
ing individual  incisors. 

One  of   the   best  and  simplest 
plans  for  moving  outward  the  in- 
ferior incisors  is  by  the  use  of  the 
•  Byrnes  metal  strips,  as  shown  in 
Fig.  150. 

Appliance  A  was  used  to  move 
all  of  the  incisors,  while  B,  C  and 
D  were  employed  to  move  individual  ones. 

Dr.  Kingsley  illustrates  and  describes  an  appliance  and 
method  for  drawing  the  lower  incisors  together  (after  one 


Fig.  150. 


PRACTIC A L    TR E ATM RNT. 


199 


Fig.  151. 


has  been  extracted)  and  moving  them  into  line  at  the  same 
time ;  Fig.  151.  He  says : — *  "  It  was  a  vulcanite  plate  with 
piano-wires,  one  from  each  side,  meeting  and  lapping  in 
front,  and  in  their  relaxed  position  standing  off  for  an 
eighth  of  an  inch  from  the  face  of  the  teeth,  but  were 

sprung   in    and 
,:^  tied  to  the  inci- 

,  \  sors  with  waxed 
!  ligatures.  This 
'  7  \'ulcanite  plate 
/  was  made  pretty 
stout,  compara- 
tively non-elas- 
tic, and  im- 
'}  /  pinged  upon  the 
lingual  walls  of 
the  bicusjjids 
and  molars,  for 
the  jnirpose  of 
assisting  nature, -which  was  widening  the  arch  by  occlusion 
with  the  upper  one,  and,  as  from  time  to  time  it  loosened  by 
those  teeth  yielding,  the  j^late  was  warmed  and  readjusted. 
A  small  ring  from  rubber  tubing  was  also  stretched  over  the 
three  teeth,  to  assist  in'  closing  the  gap.  In  four  weeks  the 
space  was  closed.      The   re-  yjg.  152. 

taining  fixture  was  exactly 
like  the  regulating  plate  with- 
out the  piano-wire  attach- 
ments." 

Another  retaining  appli- 
ance for  cases  of  this  char- 
acter,   occupying  but   little 

space  and  holding  the  teeth  firm,  is  shown  in  Fig.  152.  It 
is  most  conveniently  constructed  by  fitting  the  bands  to  the 


••-  Dental  Cosmos,  Vol.  XXXIV.,  p.  106. 


200  ORTHODONTIA. 

anchor  teeth  and  then  taking  an  impression  of  these  in  po- 
sition, together  with  the  lingual  surfaces  of  the  intervening 
teeth.  A  model  of  plaster  and  marble-dust,  made  from 
this  impression,  will  enable  us  to  fit  the  connecting  strip  and 
after  securing  it  in  place  with  binding  wire,  solder  it  to  the 
bands. 

Where  greater  accuracy  is  desired,  the  strip  may  be 
swaged  up  to  shape  by  dies  made  from  the  same  or  dupli- 
cate model. 

The  retainer  can  be  made  to  do  a  little  delicate  adjusting 
by  slightly  trimming  on  the  model  the  still  prominent 
corners  of  any  teeth  that  we  may  desire  to  move  outward. 


CHAPTER  II. 

REDUCTION    OP    ELONGATION    OF    THE    ANTERIOR    TEETH. 

Normally,  each  tooth  will  advance  in  the  course  of  its 
eruption  until  the  whole  of  its  crown  projects  beyond  the 
free  margin  of  the  gum,  and  its  cutting  edge  or  masticating 
surface  is  in  proper  relation  with  the  same  surfaces  of  the 
adjoining  teeth.  Full  eruption  may  be  delayed  or  entirely 
prevented,  but  extra  elongation  will  not  occur  except  through 
accidental  circumstances.  When  it  does  occur,  it  is  the 
result  of  an  abnormal  condition  of  the  pericementum,  most 
generally  due  to  irritation  in  some  form,  or  it  is  caused 
by  lack  of  occlusion  with  teeth  in  the  opposite  jaw.  In  the 
latter  case,  it  is  but  the  manifestation  of  nature's  attempt  to 
rid  the  system  of  a  useless  organ. 

Elongation  of  one  or  more  of  the  superior  incisor  teeth 
sometimes  occurs  in  connection  with  regulating  and  is  due 
either  to  the  irritation  of  the  soft  tissues  surrounding  the 
tooth  caused  by  the  impingement  of  the  regulating  appli- 
ance upon  them,  or  to  the  unfortunate  application  of  power 
in  such  manner  as  to  favor  the  lifting  of  the  tooth  from  its 
socket. 

When  such  elongation  is  noticed  it  becomes  necessary  to 
remove  the  cause  and  give  rest  to  the  affected  parts.  The 
elongation  being  due  in  the  first  instance  to  the  temporary 
thickening  of  the  peridental  membrane  through  irritation, 
a  period  of  rest  will  usually  result  in  the  subsidence  of  the 
trouble  and  the  return  of  the  tooth  to  its  former  position. 
Where  the  elongation  is  the  result  of  misdirection  of  power 
the  operation  will  have  to  be  suspended  for  a  time,  to  be 
followed  by  the  use  of  more  suitable  appliances.  Should  the 
condition,  however,  be  allowed  to  continue  for  any  length  of 

201 


202 


ORTHODONTIA. 


Fig.  153. 


Herbst  Method  of  Retention. 


Fig.  154. 


time,  as  through  non-appearance  of  the  patient,  some  pres- 
sure may  have  to  be  applied  to  force  tlie  tootli  back  into  its 
socket.  This  may  be  accomplished  in  a  very  simple  manner 
by  adopting  the  plan  suggested  by  Dr.  M'^ilhelm  Herbst  for 
retaining  a  replanted  tooth. 

It  consists  in  cutting  a  short  and  narrow  strip  from  a 
piece  of  rubber  dam  and  perforating  it  in  such  manner  that 
when  in  position,  the  crowns  of  two  teeth  on  either  side  of 
the  one  affected  will  protrude  through  the  openings,  while 
the  elongated  tooth  will  be  partly  covered  and  pressed  upon 

by  the  intervening  portion  of  the 
rubber.  Figs.  153  and  154  represent 
the  strip  of  rubber  separately  and  in 
position.  Anotlier  way  of  producing 
tension  upon  the  elongated  tooth  is 
by  means  of  a  rubber  plate  with  a 
strip  of  gold  so  attached  as  to  rest 
and  press  upon  the  cutting  edge  of 
the  tooth. 

More  elaborate  in  character,  but 
well  adapted  to  the  purpose,  is  the 
Rubber  strip  Applied.         appliance   dcviscd    by  Dr.  Dodge.* 
The  right  central  was  elongated  and  needed  reduction.    A 
double-cap  was  made  of  gold  to  fit  and  cover  the  left  central 
and  lateral  and  a  similar  fig.  155. 

one  to  cover  the  right 
lateral.  These  caps 
were  joined  on  their 
labial  and  palatal  sur- 
faces by  heavy  gold 
wires,  each  having  three 
headed  pins  attached  to 
it.     When  completed,  it 

was    cemented    in     posi-    Appliance  for  Reduction  of  Elongation.    (Dodge.) 

tion,  as  shown  in  Fig.  155.     The  appliance  for  furnishing 

*  Denial  Cosmos,  Vol.  XXXIII.,  p.  1045  et  seq. 


PRACTICAL    TREATJNIENT. 


203 


the  power  consisted  of  a  short  piece  of  elastic  braid,  to  one 
end  of  which  were  attached  three  small  gold  rings  and  to 
the  other  a  gold  bar  fitted  with  tube,  ring-bolt  and  nut,  as 
seen  in  Fig.  156. 

In  use  the  three  gold  rings  engaged  with  the  three  pins 

Fm.  156.    oil     palatal  fig.  157. 

bar  while  the 

ring-bolt  was 

caught    over 

the     central 

pin  on  labial 

bar.       The 

elasticity    of 

the  braid,  after  being  lessened  by  the  moving  of  the  tooth 
was  increased  by  turning  the  nut  on  the  ring-bolt. 

The  completed  fixture  in  position  is  shown  in  Fig.  157. 
None  of  the  appliances  mentioned  need  be  worn  long,  for 
the  continuous  pressure  will  quickly  cause  recession  of  the 
tooth. 


')Q6 


Appliance  in  Position.     (Dodge. 


CHAPTER   III. 

ASSISTED    ERUPTION    OF    THE    ANTERIOR    TEETH. 

Incisor  teeth  that  have  not  erupted  to  their  full  extent  and 
have  been  prevented  from  doing  so  by  too  close  proximity 
of  adjoining  teeth  or  other  cause,  may  often  be  assisted  in 
assuming  their  proper  alignment.  Where  space  exists,  teeth 
will  naturally  accomplish  their  full  eruption  unaided,  as 
previously  stated.  When  they  do  not,  and  there  is  no  visible 
cause  for  their  not  doing  so,  we  may  safely  infer  that  some 
hindrance  exists  in  the  tissues  beneath  the  gum.  It  may 
only  be  an  unexplainable  suspension  of  the  act  of  eruption, 
or  it  may  be,  and  often  is,  a  curvature  or  enlargement  of 
the  root  that  prevents  the  further  progress  of  the  tooth. 
Which  of  the  two  it  is,  can  usually  only  be  decided  after 
measures  of  assistance  have  been  tried. 

If  the  delayed  eruption  has  been  due  simply  to  a  suspen- 
sion of  the  act  of  eruption,  the  simplest  and  most  effective 
remedy  will  be  found  in  tying  a  silk  ligature  around  the 
neck  of  the  tooth  and  pressing  it  well  under  the  free  margin 
of  the  gum,  or  in  placing  a  ring  cut  from  rubber  tubing  in 
the  same  position.  Either  one  will  cause  irritation  of  the 
pericementum,  which  by  consequent  enlargement  will  tend 
to  force  the  tooth  out  of  its  socket.  To  prevent  undue  elon- 
gation the  case  will  have  to  be  carefully  watched,  day  by 
day,  and  the  irritating  ligature  removed  as  soon  as  the  tooth 
has  been  sufficiently  elongated.  Should  this  be  neglected, 
the  tooth  might  be  entirely  expelled  and  lost. 

Should  these  simple  means  fail  to  move  the  tooth  from  its 
abnormal  position,  osseous  abnormality  is  probably  the  hin- 
dering cause,  and  mechanical  apj^diances  of  not  too  great 
power  should  be  tried.  Some  of  this  character  have  been 
mentioned  in  Part  III.,  Chapter  2. 

204 


PRACTICAL    TREATMENT.  205 

Dr.  A.  E.  Matteson  *  has  devised  an  appliance  for  produc- 
ing forced  elongation  of  several  of  the  incisor  teeth  at  the 
same  time.  It  is  composed  of  a  rubber  plate  to  which  a 
piece  of  clock  spring,  properly  shaped,  is  attached.  The 
spring  is  cut  and  ground  along  its  outer  edge  in  such  man- 
ner as  to  leave  projections  to  pass  between  the  teeth  at  their 
necks  and  bear  upon  the  wider  parts  of  the  crowns.  After 
being  properly  shaped  and  fitted,  the  spring  is  riveted  to 
the  anterior  portion  of  the  plate  just  back  of  the  teeth  to  be 
acted  upon.  In  inserting  the  appliance,  the  projections  of 
the  spring  are  passed  between  the  teeth  at  their  necks  and 
the  plate  pressed  into  place.  The  elasticity  of  the  slightly 
curved  spring  with  its  projections,  will  produce  pressure  upon 
the  teeth  in  the  direction  of  their  length  and  cause  their 
elongation. 

The  action  of  all  appliances  of  this  character  will  have  to 
be  closely  watched  to  see  that  the  force  exerted  by  them  is 
neither  too  great  nor  too  long  continued. 

Should  any  or  all  of  the  appliances  mentioned  fail  to 
move  the  partially  erupted  tooth,  we  may  safely  conclude 
that  its  root  is  exostosed  or  curved  at  some  point  of  its 
length,  and  further  operations  had  better  be  suspended. 

The  author,  in  his  early  practice,  attempted  to  rotate  a 
superior  cuspid  tooth,  and  after  failing  to  produce  any  effect 
by  the  commonly  adopted  appliances,  concluded  that  the 
trouble  must  lie  in  the  formation  of  the  root.  A  digital 
examination  of  the  tissues  overlying  the  root,  revealed  the 
fact  that  it  was  considerably  curved,  and  further  efforts  at 
rotation  were  immediately  abandoned.  Had  the  examina- 
tion been  made  before  beginning  operations,  as  it  should 
have  been,  instead  of  at  their  close,  much  annoyance  and 
trouble  would  have  been  spared  both  patient  and  ojjerator. 

Where  full  eruption  of  a  tooth  has  been  made  impossible 
I'jy  the  impingement  of  adjoining  teeth  upon  the  space  in- 
tended for  it,  increase  of  space  by  lateral  pressure  upon  the 

*  Harris'  Principles  aud  Practice,  12  Ed.,  p.  439. 


206  ORTHODONTIA. 

interfering  teeth  should  first  be  gained  before  any  attempt 
is  made  at  elongation.  Indeed,  the  mere  enlargement  of 
the  space  and  its  retention  for  a  length  of  time  will  usually 
be  followed  by  the  unaided  eruption  of  the  tooth.  Should 
this  not  occur,  mechanical  assistance  may  be  rendered  by 
some  of  the  niethods  mentioned. 

Forcible  eruption  of  a  tooth  by  means  of  the  extracting 
forceps  is  seldom  justifiable,  for  we  cannot  alw^ays  know 
what  may  have  interfered  with  the  eruption.  In  certain 
exceptional  cases,  where  a  careful  examination  reveals  no 
sign  of  malformation  of  the  root,  and  where  it  is  perfectly 
evident  that  slight  impingement  of  adjoining  teeth  has  been 
the  sole  hindrance  to  full  eruption,  the  forceps  may  prove  a 
valuable  means  of  effecting  a  rapid  and  easy  correction  of 
the  difficulty. 

Such  a  case  occurred  in  the  author's  practice.  The  patient 
was  a  gentleman  of  about  twenty-eight  years  of  age,  whose 
right  central  incisor  was  about  ^jf.  I5g_ 

a  line  shorter  than  its  mate.  It  ^-.^^^^^^^^^^^ 

had  been  tardy  in  erupting  and  ■■i!^^^^^^^''^''^\^'^^^^ 
in  consequence  there  was  a  w^.;- i__J  '  f  f  w 
slight  lack  of  space  for  its  ac-    t  .W"^'^  ^~'^'^\J 

COmmodation,       as      shown       in  incomplete  Eruption. 

Fig.  158. 

As  the  difference  in  length  of  the  two  incisors  was  too 
great  to  be  remedied  by  the  simple  means  of  reducing  the 
length  of  the  longer  one,  it  was  decided  to  elongate  the 
shorter  one.  A  careful  examination  proving  favorable,  a 
piece  of  sand  paper  was  folded  so  as  to  cover  both  labial 
and  palatal  surfaces  of  the  tooth  to  protect  it  from  injury, 
after  which  it  was  grasped  with  the  forceps  and  by  a  combined 
rotary  and  downward  motion  brought  into  place.  Once  in 
position,  it  was  held  there  firmly  by  the  pressure  of  the  ad- 
joining teeth,  but  as  good  judgment  would  not  sanction  so 
unreliable  a  means  of  retention,  an  appliance  had  to  be 
devised  that  would  not  only  prevent  the  tooth   from  slip- 


PRACTICAL    TREATMENT.  207 

ping  back  into  its  socket  but  also  secure  it  from  being 
forced  forward  by  pressure  upon  its  sides.  The  patient  also 
desired  the  appliance  to  be  as  inconspicuous  as  possible. 

To  accomplish  all  of  these  ends,  a  piece  of  platinized  gold 
wire,  a  little  thicker  than  a  vulcanite  tooth-pin,  was  bent 
into  horseshoe  form  and  curved  to  conform  to  the  palatal 
surfaces  of  the  retarded  tooth  and  the  two  adjoining  ones. 
The  ends  of  the  wire  were  then  flattened  and  bent  so  that 
they  would  hook  over  and  rest  upon  the  cutting  edges  of 
the  adjoining  central  and  lateral.  A  silk  ligature  was  passed 
around  the  moved  tooth  and  tied  in  front,  after  which  the 
ends  were  again  passed  to  the  palatal  surface  and  tied 
just  below  the  cingulum.  After  the  gold  wire  was  placed  in 
position,  the  ligature  was  attached  to  it  at  the  lowest  point 
of  its  central  curve. 

The  ligature  thus  held  the  appliance  in  position  and  it  in 
turn  kept  the  tooth  from  receding.     The  double  arrange- 
p^P^  159  ment  of  wire  and  ligature  also 

guarded  the  tooth  against  the 
possibility  of  moving  forward. 
The  fixture  in  position  is  shown 
in  Fig.  159.     The  only  parts  of 

Retention  alter  Coirectiou.  it       visiblc       WCrC       the         SUiall 

rounded  gold  tips  that  overlapped  the  cutting  edges  of  the 
two  adjacent  teeth. 

Where  sufficient  space  exists  for  the  purpose,  the  tooth 
after  being  drawn  into  position  may  be  held  by  means  of  the 
platinum  band  and  extension  bar,  as  shown  elsewhere  for 
retaining  a  tooth  that  has  been  forced  backward  into  the  line 
of  the  arch. 


CHAPTER   IV. 


TOOTH-SHAPING. 


During  the  act  of  regulating  or  after  its  accomplishment, 
one  of  the  most  useful  accessory  operations,  when  called  for, 
is  that  of  dressing  or  shaping  certain  teeth  so  as  still  further 
to  improve  their  appearance. 

This  operation  will  probably  not  be  necessary  in  the 
majority  of  cases  we  treat,  but  when  indicated,  it  adds 
very  much  to  the  patient's  appearance  and  the  satisfaction 
of  the  parent  and  operator.  It  may  be  accomplished  by 
means  of  the  file,  corundum  point,  sand-paper  disk  or  emery 
cloth  strips,  each  having  value  according  to  the  require- 
ments of  the  case. 

It  will  not  often  be  called  for  on  the  approximal  surfaces 
of  teeth,  but  when  it  is,  much  of  the  substance  should  not 
be  removed  and  the  surface  should  afterward  be  polished 
in  the  most  perfect  manner. 

The  author  has  had  one  case,  and  one  only,  in  which  such 
trimming  of  approximal  surfaces  seemed  advisable.  The 
patient  was  a  young  lady  of  about  twenty-one  years  of  age, 
whose  anterior  superior  teeth  were  slightly  prominent.  The 
teeth  were  without  interdental  spaces  and  all  of  the  jDosterior 
ones  were  so  perfect  in  structure,  alignment  and  occlusion, 
that  the  extraction  of  even  one  of  them  would  have  been 
regarded  as  an  unwarrantable  sacrifice. 

All  of  the  six  anterior  teeth  had  small  cavities  upon  each 
of  their  approximal  surfaces,  and  it  was  therefore  decided 
that  in  the  filling  of  these  cavities  a  sliglit  portion  of  each 
approximal  surface  should  be  dressed  off  in  the  hope  that 
the  aggregate  of  such  spacing  would  be  sufficient  to  enable 
the  teeth  to  occupy  a  position  more  in  harmony  with  the 
normal  line  of  the  arch.     After  the  filling  and  dressing  of 

208 


PRACTICAL    TRKATMEXT. 


209 


Elongated  Centrals. 
Fig.  162. 


the  surfaces,  the  teeth  were  drawn  inward  and  the  result  was 
all  that  could  have  been  desired. 

Sometimes  teeth  that  have  fully  erupted  out  of  line, 
when  brought  into  proper  position  extend  below  the  line  of 
the  cutting  edges  of  their  neighbors  and  the  rest  of  the  teeth 
in  the  arch.  Any  attempt  to  reduce  their  elongation  by 
forcing  them  up  into  the  socket  would  not  only  be  extremely 
difficult,  but  in  many  cases  futile.  The, better  plan,  if  the 
disparity  in  length  be  not  great,  is  to  grind  off  their  cutting 
edges  somewhat,  and  thus  accomplish  the  desired  end  in  a 
very  simple  manner. 

Fig.  160.  Fig.    lOO  Fig.  161. 

shows  a  case 
of  this  char- 
acter, and 
Fig.  161  the 
improvement 
(How.)  after  grind- 
ing. 
Again,  teeth  out  of 
line  have  from  lack  of 
attrition  preserved  their 
normal,  rounded  form, 
while  their  fellows  have  improvement, 
been  more  or  less  worn  away  on  their  cutting  edges  either 
through  abnormal  occlusion  or  excessive  use.  When  the 
mal[)0sed  teeth  have  been  brought  into  position  their 
rounded  and  unworn  cutting  edges  are  apt  to  contrast 
strongly  with  the  abraded  edges  of  their  neighbors.  By  so 
dressing  the  incising  edges  of  the  unworn  teeth  as  to  resem- 
ble those  next  to  them,  greater  harmony  of  expression  will 
result. 

Fig.  162  illustrates  a  case  in  which  the  worn  condition 
and  varying  length  of  the  lower  anterior  teeth  presented  a 
very  unsightly  appearance,  and  Fig.  163  represents  the 
improvement  made  by  reducing  the  length  of  certain  ones 
and  straightening  the  edges  of  others  by  grinding. 


ImprovL'iiiL'iit  b\'  i.Triiiding. 

Fig.  163. 


Unevenly  \\om  I 
■  (How.) 


210  ORTHODONTIA. 

Altering  the  form  of  a  tooth,  however,  may  often  be  made 
to  serve  even  a  more  useful  purpose  than  that  of  appearance. 
Cases  have  occurred  where  an  upper  tooth,  tardy  of  eruption, 
has  been  unable  to  come  entirely  down  into  line  owing  to 
the  meeting  of  its  antagonist  of  the  opposite  jaw  edge  to  edge. 
In  such  an  event,  the  retarded  tooth  might  be  forced  suffi- 
ciently outward  to  enable  it  to  accomplish  its  full  erup- 
tion and  then  be  held  in  position  until  overlapping  had 
taken  place,  but  the  operation  may  be  advantageously  sim- 
plified in  most  cases  by  slightly  beveling  the  edge  or  cusp  of 
the  lower  tooth  on  its  labial,  and  the  upper  one  on  its  pala- 
tal surface.  The  inclined  plane  thus  formed  will  enable 
the  upper  tooth  to  slide  over  the  lower  one  into  line,  which 
it  will  be  almost  certain  to  do  provided  there  be  no  contin- 
gent obstructions. 

A  case  of  this  character  came  under  the  author's  notice 
recently  in  which  a  superior  lateral  incisor  was  thus  impeded 
in  eruption  until  the  individual  was  forty  years  of  age.  A 
simple  beveling  of  the  cutting  edges  of  it  and  its  opponent, 
induced  it  to  come  into  proper  line  within  a  year. 

Other  conditions  than  those  just  mentioned  will  occur  to 
the  practitioner  in  which  the  slight  alteration  of  the  form  of 
a  tooth  will  materially  assist,  or  be  the  means  of  entirely 
accomplishing  some  simple  act  of  regulating,  and  in  other 
cases,  greatly  add  to  the  effect  of  some  long-continued  and 
otherwise  successful  operation  in  orthodontia. 


CHAPTER  V. 

CONSTRUCTION    OF    EEGULATINfi    APPLIAN'CES. 

The  principal  tools  required  for  the  construction  of  metal 
regulating  appliances  are  illustrated  in  Plates  I.  and  II. 

"  a  "  is  the  ordinary  mouth  hlow-pipe  to  be  used  in  con- 
nection with  a  large  alcohol  annealing-lamp  or  gas  Bunsen 
burner ;  "  6 "  is  the  best  form  of  jeweler's  pin-vice,  hav- 
ing pivoted  jaws  operated  by  an  inclined  plane  on  revolv- 
ing handle.  The  handle  is  bored  entirely  through  to  re- 
ceive wire  of  any  length.  "  c  "  is  a  "  snip  "  plate  shears  of 
the  form  recently  introduced  for  crown-  and  bridge-work. 
"  d  "  is  a  dental  pin-punch  and  "/"  a  solder  tweezers.  "  e" 
is  known  as  a  clasp-bender,  and  with  its  one  beak  of 
cylindrical  form  and  the  other  concave  is  a  powerful  and 
useful  instrument  for  curving  and  shaping  piano  or  other 

stiff  wire. 

"  g  "  and  "  h  "  are  respectively  flat  and  round  nose  pliers, 
while  "  i  "  is  a  heavy  pliers  for  drawing  wire  or  tubing,  with 
notches  in  the  joint  for  cutting  wire,  "j  "  is  a  small  steel 
anvil  mounted  in  a  metal  base,  and  "  m  "  is  a  jeweler's  saw- 
frame  and  saw.  "  ^  "  is  a  small  jeweler's  set  of  taps  and 
dies  for  cutting  threads  in  nuts  or  upon  wire,  while  "  I "  is  a 
screw  plate,  (Stubs  No.  19)  usually  accompanied  by  corres- 
ponding taps  for  the  same  purpose.  "  n  "  is  a  cut-nippers, 
and  "  0  "  a  pair  of  contouring  pliers,  as  used  in  crown-work, 
"p  "  is  a  copper  soldering  iron  for  soft  soldering,  and  "  q  " 
and  "  r  "  metal  gauges.  "  q  "  is  the  Standard  American 
Gauge,  very  generally  used  for  both  plate  and  wire.*      "  r  " 

"inasmuch  as  confusion  has  arisen  at  times  in  describing  the  different 
thicknesses  of  wire  and  plate  used  in  dental  work,  some  writers  using  the 
English  Standard  Wire  Gauge  (which  is  similar  to  the  Birmingham  and 
Stub's  gauges),  others  the  American  Standard  Wire  Gauge  (sometimes  called 
the  Brown  and  Sharpe  or  B.  &  S.),  while  nearly  all  number  piano  wire  ac- 

211 


212  ORTHODONTIA. 

is  a  micrometer  gauge  for  more  delicate  and  accurate 
measurements,  which  are  indicated  in  thousandths  of  an 
inch.  "  s  "  is  a  double-calliper,  with  one  end  for  inside  and 
the  other  for  outside  measurement. 

"  i  "  is  a  self-closing  tweezers  for  holding  parts  in  solder- 
ing, and  "  li "  a  draw-plate,  known  as  the  "  Joubert,"  with 
thirty  different  sizes  of  holes.  The  illustrations  "^'"  to  "2" 
will  be  referred  to  in  the  description  of  processes.  "  aa  "  re- 
presents a  metal  ferrule  or  band,  the  edges  being  drawn  tight 
and  held  together  with  fine  iron  binding-wire.  "  bb,"  "  cc '' 
and  "  dd  "  are  simple  forms  of  wire  clips  for  holding  parts  in 
position  while  soldering.  The}''  are  made  from  piano- wire, 
Nos.  17  to  21,  each  about  an  inch  in  length.  In  "  bb  '' 
both  ends  are  beveled  inward  to  enable  them  more  easily 
to  slip  over  the  parts  to  be  held.  In  "  cc  "  one  end  of  the 
clip  is  formed  into  a  Ioojd  and  the  other  bent  at  a  right 
angle  with  fiat  termination.  "  dd "  is  a  modification  of 
"  bb,"  one  arm  being  curved  near  its  end  to  hold  a  tube  in 
parallel  position  upon  a  band. 

"  gg  "  is  intended  to  represent  the  manner  of  holding  a 
tube  at  right  angles  to  the  length  of  the  band.  The  wire 
clip  for  this  purpose  has  one  arm  bent  at  a  right  angle  near  its 
end  and  flattened  and  made  concave  to  fit  the  tubing,  while 
the  other  arm  is  straight,  as  in  "  bb." 

"  hh  "  represents  a  simple  wire  support  for  holding  parts 
in  position  upon  a  soldering  block,  as  in  constructing  a  gold 
T.  The  supjDort  is  made  from  a  piece  of  piano-wire  flattened 
and  drilled  at  one  end,  tapering  to  a  point  at  the  other 
and  bent  at  a  right  angle  near  the  middle.  The  pointed 
end  is  easily  forced  into  an  asbestos  or  charcoal  block  at 
any  desired  place. 

cording  to  the  Steel  Music  Wire  Gauge  (Washburn  &  Moen  Co.),  the 
author  would  suggest  the  adoption  by  American  dentists  of  the  American 
Standard  Gauge  (B.  &  S.)  for  indicating  the  thickness  of  all  plate  and  wire 
used  for  dental  purposes.  The  numbers  indicated  in  this  chapter  refer  to  the 
B.  &  S.  gauge.  A  comparative  table  of  the  various  gauge  measurements,  by 
which  the  equivalent  of  one  may  be  found  in  any  other  is  appended  to  this 
chapter. 


Platk  I. 


I'l.ATi-:  [I. 


PRACTICAL    TREATMENT.  213 


FERRULES    OR    RANDS. 


Ferrules  or  bands  for  encircling  teeth  and  serving  as 
means  of  attachment  for  operating  or  retaining  appliances 
may  be  made  from  gold  plate  (IS  to  22  karats  fine),  platinized 
gold,  iridio-platinum,  platinum,  platinized  silver  or  German 
silver.  All  of  those  mentioned,  except  the  last,  will  remain 
nearly  free  from  oxidation,  but  German  silver  soon  becomes 
dark  in  the  mouth.  As  a  rule,  bands  should  be  made  to 
fit  loosely  so  as  to  afford  slight  space  for  the  cement  which 
is  to  hold  tliem  in  position,  and  where  practicable,  the  tooth 
to  be  fitted  should  be  freed  from  contact  with  its  neighbors 
by  previous  wedging.  As  this  cannot  always  be  done,  the 
bands  in  some  cases  will  have  to  be  forced  over  the  teeth  in 
spite  of  tlieir  contact.  In  such  event  they  should  be  con- 
structed from  the  stifFest  and  least  yielding  of  the  metals 
mentioned,  such  as  platinized  gold,  platinized  silver,  or 
iridio-platinum.  Bands  made  from  these  metals,  even 
though  thin,  will  retain  their  form  without  "  buckling " 
while  being  forced  into  place.  Where  the  teeth  to  be  banded 
are  not  in  close  contact,  any  of  the  other  metals  will  serve  as 
well  for  the  construction  of  bands.  The  band  material 
should  not  exceed  No.  32  in  thickness  and  should  be  cut 
into  strips  from  -3%  to  ^^2  of  ^n  incli  in  width. 

For  the  six  anterior  teeth  the  strips  should  be  curved  as 
shown  in  " z"  so  that  when  bent  to  encircle  the  tooth  with 
the  convex  edge  toward  the  gum,  the  ends  will  meet  one 
another  or  overlap  on  the  lingual  surface  in  a  nearly  hori- 
zontal line. 

For  molars  and  bicuspids  the  band  should  be  straight, 
and  if  desired,  may  be  contoured  transversely  with  the  con- 
touring pliers  ( 0 ). 

Ferrules  are  neatest  when  made  with  a  flush  joint,  and 
their  ends  may  be  held  in  close  apposition  by  passing  bind- 
ing wire  around  them  {aa)  and  twisting  the  ends  to  serve  as 
a  holder  while  soldering  in  the  flame  of  a  lamp.     When 


214  ORTHODONTIA. 

made  with  a  lap  joint  they  may  be  secured  in  the  same  way 
or  the  lapped  ends  may  be  held  witli  a  wire  clip  (bb). 

In  some  cases,  as  in  partly  erupted  cuspids  and  deciduous 
molars,  where  the  exposed  portion  of  the  crown  is  short  and 
conical,  it  is  important  to  have  the  band  more  accurately 
adapted  to  the  form  of  the  tooth  so  as  to  gain  a  firmer  hold. 

This  may  easily  be  accomplished  by  reproducing  the 
crown  in  Melotte's  metal,  and  after  roughly  adapting  the 
band  to  the  natural  tooth  or  its  duplicate  in  plaster,  com- 
pleting the  operation  on  the  metal  crown  with  hammer  and 
chaser,  or  by  swaging  it  between  a  die  and  counter.  Prof. 
Matteson  prefers  the  latter  plan,  the  results  of  which  are 
nicely  shown  in  Fig.  65,  p.  123. 

The  attachments  that  bands  are  most  commonly  supplied 
with  are  headed  pins,  wire  hooks  and  pieces  of  metal  tubing. 
Tubes  are  held  in  position  upon  bands  for  soldering  by 
means  of  wire  clips  as  shown  in  "  dd  "  and  "  gg." 

As  tubes  are  usually  not  soldered  along  their  edges  after 
being  drawn,  they  can  be  closed  at  the  time  of  soldering  to 
the  bands  by  placing  the  joint  next  to  the  band,  and  when 
desired  to  be  left  open  the  joint  is  turned  away  so  as  not  to 
be  included  in  the  soldering. 

Headed  pins  may  be  obtained  from  a  vulcanite  tooth  and 
after  being  filed  to  a  point  can  be  inserted  into  a  hole  drilled 
in  the  band,  as  shown  in  "ff" 

When  a  band  is  to  be  supplied  with  hooks  on  opposite 
sides,  a  convenient  way  of  attaching  them  is  to  drill  a  hole 
in  each  side  of  the  1  )and  and  pass  entirely  through  them  a 
wire  bent  into  a  hook  at  one  end  as  shown  in  "  ee."  After 
soldering,  the  straight  end  is  also  bent  and  the  wire  cut  from 
the  centre  of  the  band.  A  hook  for  one  side  only  may  be 
inserted  and  held  like  the  pin  in  "J\" 

ROUND    TUBING. 

Tubing  for  pipes  or  tubes  can  usually  be  obtained  at 
jeweler's  supply  houses.  It  may  be  had  of  gold,  brass  or 
German   silver  or  of  one  of  the   latter  metals  plated.      It 


PRACTICAL    TREATMENT.  215 

comes  in  lengths  of  about  foiu^  inches,  and  is  smoothly  drawn 
but  not  soldered  (x). 

The  thickness  of  the  tubes  is  generally  greater  than  we 
desire,   but   after   soldering  the  joints   with   silver   solder, 
the  inside  diameter  can  be  enlarged  with  an  engine  bur,  a 
spear  or  fissure  drill,  or  jeweler's  reamer.     In  many  cases  it 
may  be  desirable  or  necessary  to  manufacture  our  own  tub- 
ing, which  can  be  done  as  follows :     Select  a  piece  of  metal 
plate  of  suitable  gauge  (No.  27)  and  cut  from  it  a  stri^)  of  de- 
Wed    length  and  of  a  width  equal  to  three  and  a  third 
times  the  outside  diameter  of  the  proposed  tubing  ( v  ).   Shape 
one  end  of  the  strip  like  the  nib  of  a  pen  and  curve  or  round 
the  entire  piece  somewhat  by  forcing  it  into  a  groove  cut  in 
a  block  of  hard  wood,  using  a  piece  of  wire  and  hammer  for 
the  purpose  (iv).      The  pointed  end  is  then  passed  into  one 
of  the  larger  holes  of  the  draw-plate,  seized  with  the  pliers 
( i  )  and  drawn  through.    This  operation  is  repeated  through 
the  holes  next  in  size  until  tlie  cut  edges  of  the  strip  are  in 
close  apposition.      If  it  be  desired  to  reduce  the  external 
diameter  after  "the  tube  is  formed,  it  can  be  done  by  simply 
continuing  the  process.      As  the  drawing  stiffens  the  metal 
it  will  be  necessary  to  anneal  it  occasionally  during  the 
process.     Where  the  tubing  is  to  be  used  in  considerable 
lengths  without  soldering,  where  great  stiffness  is  required, 
as  in  the  Angle  encasement  for  jack-screws,  there  should  be 
no  annealing  of  the  metal  near  the  close  of  the  operation  of 
drawing. 

SQUARE    TUBING. 

This  form  of  tubing  can  seldom  be  bought,  and  so  will 
have  to  be  manufactured.  The  strip  will  first  have  to  be 
converted  into  a  round  tube,  as  previously  described,  and 
drawn  to  near  the  proper  size  in  the  ordinary  draw-plate, 
after  which  the  last  four  or  five  drawings  must  be  made 
through  a  square  hole  draw-plate.  This  form  of  tubing  ( y ) 
when  made  [of  plate  a  little  heavier  than  usual,  and  drawn 


216  ORTHODONTIA. 

to  a  size  to  fit  the  wrench  or  key,  is  admirably  adapted  for 
the  construction  of  small  nuts  as  well  as  heads  of  screws. 

Sections  of  any  length  can  be  cut  from  it  with  a  jeweler's 
saw,  after  which  by  grasping  them  in  a  hand-vise  ( 6 )  they 
may  be  readily  drilled  or  reamed  to  proper  size  and  tapped. 
The  saw  should  always  be  set  in  the  frame  with  the  teeth 
pointing  toward  the  handle  so  that  the  cutting  is  done  in 
drawing  the  saw  backward.  Reversing  the  operation  would 
cause  the  back  of  the  frame  to  spring  and  the  saw  be  liable 
to  break  in  consequence. 

WIRE-DRAWING. 

The  process  of  drawing  wire  down  to  size  is  very  similar 
to  that  of  drawing  round  tubing.  Steel  wire  cannot  be 
drawn  by  hand,  but  can  be  bought  in  all  sizes.  Gold, 
platinum  or  German  silver  wire,  however,  can  readily  be  re- 
duced in  diameter  and  correspondingly  lengthened  by 
means  of  the  draw-plate  (u)  and  the  heavy  pliers  (i). 
Before  using  the  draw-plate,  the  holes  should  be  filled  with 
melted  bees-wax  or  equal  parts  of  bees-wax  and  tallow  to 
act  as  a  lubricant.  It  is  then  clamped  firmly  in  the  bench- 
vise.  The  wire  after  being  annealed  should  be  reduced  at 
one  end  by  filing  or  hammering  and  the  pointed  end  passed 
througli  the  hole  in  the  draw-plate  next  less  in  diameter 
than  the  wire  itself.  It  is  then  grasped  by  the  pliers  (  ^ ) 
and  drawn  through  with  a  continuous  and  steady  pull.  In 
similar  manner  it  is  drawn  through  the  successivel}^  smaller 
holes  until  the  desired  gauge  is  obtained.  After  each  three 
or  four  drawings  the  wire  should  be  annealed,  otherwise  its 
increasing  brittleness  may  cause  it  to  break. 

Bending  ivire. — Wire  may  be  bent  into  any  form  by  means 
of  the  various  pliers,  assisted  at  times  by  the  bench-  or  hand- 
vise.  Any  curve  can  be  given  to  it  with  the  round-nose  pliers 
( h ),  while  for  bending  it  to  a  right  or  acute  angle,  it  should 
be  held  in  the  vise  or  pliers  close  to  the  desired  place  and  the 
free  end  grasped  and  bent  over  by  the  flat-nose  pliers.  If 
the  wire  be  of  large  size  it  may  best  be  bent  to  a  right  angle 


PRACTICAL    TREATMENT.  217 

by  grasping  it  in  the  bench-vise  and  forcing  the  free  end 
down  with  a  hammer. 

When  piano  wire  needs  a  sharp  bend  it  should  always  be 
done  in  this  latter  manner.  For  bending  piano  wire  into  a 
short  curve,  as  for  making  or  altering  the  form  of  the  Coffin 
W  spring,  the  clasp-benders  (e)  should  be  used,  on  account  of 
their  convenience  and  superior  power. 

SOFT-SOLDERING. 

In  uniting  small  parts  of  appliances  by  means  of  soft- 
solder,  they  may  be  held  in  the  tweezers  (/),  (t)  or  the  spring 
clips  bb,  cc,  dd,  or  wrapped  with  binding  wire.  After  apply- 
ing the  soldering  fluid,  the  piece  is  held  over  an  annealing 
lamp  and  when  sufficiently  heated  is  touched  with  the  end 
of  a  thin  rod  of  solder  which  at  once  melts  and  unites  the 
parts.  In  this  way  the  minimum  amount  of  solder  may  be 
applied. 

For  soldering  larger  parts  of  appliances,  as  in  forming  the 
Jackson  cribs  and  springs,  they  should  be  secured  in  proper 
position  on  the  plaster  model,  and  after  applying  the  fluid 
and  laying  a  piece  of  solder  on  the  parts,  the  latter  is 
melted  and  the  parts  joined  with  the  soldering  iron  (p ), 
previously  heated  over  a  Bunsen  burner.  In  soldering  steel 
(as  23iano-wire)  the  fluid  causes  oxidation  of  the  metal  so 
quickly  that  it  is  imj^ortant  to  heat  the  parts  and  melt  the 
solder  immediately  after  the  fluid  is  applied. 

HARD-SOLDERING. 

Both  the  student  and  practitioner  are  supposed  to  be 
familiar  with  this  process,  so  that  but  few  suggestions  will  be 
needed. 

Parts  of  German  silver  appliances  should  be  soldered  with 
silver  solder  (silver  2,  brass  1)  while  any  of  the  compounds 
of  gold  or  platinum  may  be  united  with  either  silver  or 
gold  solder.  The  latter  when  used  should  not  be  less  than 
18  karats  fine  to  keep  its  color  in  the  mouth.  In  joining 
articles  with  hard  solder  the  parts  to  be  united  should  be 


218  ORTHODONTIA. 

touched  with  the  least  quantity  of  liquified  borax  and  only 
as  much  solder  applied  as  is  necessary. 

After  drying  with  moderate  heat,  the  full  flame  should  be 
■directed  upon  the  parts  to  be  united  and  fusion  accom- 
plished as  quickly  as  possible.  Most  of  the  hard-soldering 
required  in  constructing  portions  of  regulating  appliances 
may  be  done  by  holding  the  parts  in  the  flame  of  a  small 
Bunsen  burner  or  alcohol  annealing  lamp.  In  other  cases 
a  larger  flame  with  a  blow-pipe  to  direct  and  concentrate  it 
will  be  necessary,  the  parts  being  laid  or  secured  in  position 
"upon  a  soldering  block  made  of  charcoal,  asbestos,  pumice- 
stone  or  other  suitable  substance. 

When  two  solderings  are  necessary  for  the  same  piece,  the 
first  joint  may  be  kept  from  unsoldering  during  the  second 
process  by  placing  an  extra  wire  clip  upon  it  or  by  seizing 
it  with  the  tweezers  at  that  point  and  thus  protecting  it 
from  over-heating. 

In  soldering  bands  together  as  in  Fig.  19,  they  may 
conveniently  be  held  by  means  of  the  clip  "'  66,"  while  a  band 
and  bar,  as  in  Fig.  17,  may  be  held  in  the  same  manner. 

When  two  pieces  of  tubing  are  to  be  united  at  other  than 
a  right  angle,  they  may  be  arranged  and  held  in  position 
upon  the  soldering  block  by  being  pinned  down  with  staples 
made  from  piano  wire.  The  end  of  one  piece  will  of  course 
have  to  be  filed  concave  to  fit  the  convex  surface  of  the 
other,  before  joining. 

Where  it  is  desired  to  lengthen  a  traction  screw,  it  may  be 
done  with  less  labor  than  constructing  a  new  one,  by  cutting 
it  in  two  at  some  point,  inserting  a  new  piece  of  like  diame- 
ter, and  uniting  with  solder.  The  parts  may  be  held  in 
position  by  being  pinned  to  some  smooth  surface  of  the 
soldering  block,  or  a  groove  may  be  made  in  the  block  with 
a  straight  piece  of  wire  and  hammer  and  the  parts  to  be 
united  laid  into  it.  A  wire  may  be  shortened  in  like 
manner. 

When  a  wire  or  a  tube  is  to  be  joined  to  another  at  a  right 
angle,  they  may  be  held  as  shown  in  "  hh,"  which  is  also 


PRACTICAL    TREATMENT.  219 

one  of  the  best  means  for  holding  two  flat  pieces  of  metal  for 
soldering,  as  in  constructing  a  T  appliance. 

A  screw  cut  wire  may  be  fitted  with  a  square  end  for 
turning  with  a  key,  by  filing  it  to  a  smaller  diameter  and 
slipping  over  it  and  soldering  a  section  of  square  tubing.  If 
a  shoulder  is  wanted  in  addition,  a  small  washer  or  disk 
may  be  placed  on  the  wire  before  the  square  tubing  is 
adjusted.     Both  will  be  united  at  the  same  soldering. 

SCREWS    AND    NUTS. 

The  making  of  jack-  or  traction-screws  and  nuts  to  play 
upon  them  is  an  operation  requiring  care,  but  is  not  beset 
with  much  difficulty. 

A  set  of  taps  and  dies  {k)  or  a  screw-plate  (l)  with  corres- 
ponding taps,  can  be  procured  at  jeweler's  supply  houses  or 
from  dealers  in  fine  tools,  and  they,  with  a  bench  or  pin- 
vise  and  a  few  tools  such  as  files,  and  pliers,  together  with  a 
few  sizes  of  jeweler's  reamers  will  furnish  us  with  all  the 
equipment  we  need  for  the  purpose. 

Screws. — The"  wire  that  is  to  be  threaded  or  screw-cut, 
should  be  smoothly  drawn  and  of  moderate  temper.  The 
form  that  one  end  of  the  wire  is  to  have  may  be  given  to  it 
either  before  or  after  the  thread  is  cut  upon  the  other,  but  in 
most  cases  it  will  be  well  to  fashion  it  first.  The  wire  should 
be  of  exactly  the  same  diameter  as  the  hole  in  the  screw- 
plate  would  be  if  the  threads  were  removed.  If  smaller  than 
this,  a  full,  deep  thread  will  not  be  cut,  and  if  larger,  the 
wire  will  be  liable  to  be  twisted  off"  in  the  attempt.  In  cut- 
ting the  thread,  the  wire  should  be  slightly  tapered  at  its 
end  and  grasped  in  the  bench-vise,  horizontally  or  vertically, 
with  only  about  half  an  inch  of  its  length  protruding.  To 
avoid  marring  the  wire,  the  jaws  of  the  vise  should  be  pro- 
vided with  lead  or  brass  caps. 

The  screw-plate  (or  die)  should  now  be  held  against  the 
end  of  the  wire  at  right  angles  to  it  and  given  a  quarter  or 
half  turn  with  firm  pressure.  This  should  be  repeated  four 
or  five  times  until  the  tool  is  well  started  in  its  work,  care 


220  ORTHODONTIA. 

being  taken  to  preserve  the  forward  pressure  and  to  see  that 
the  screw-plate  is  kept  at  a  right  angle  to  the  wire.  The 
operation  may  now  proceed  more  rapidly  until  all  of  the 
exposed  portion  of  the  wire  has  been  covered. 

If  a  longer  portion  is  to  be  threaded,  more  of  the  wire4may 
now  be  exposed  and  the  operation  continued.  A  little  oil 
fed  to  the  tool  will  greatly  facilitate  the  cutting.  In  re- 
versing the  operation  to  release  the  tool,  care  should  be 
exercised  not  to  mar  the  thread.* 

Nuts. — For  use  in  regulating  appliances,  nuts  should  be 
square  and  about  No.  13  in  diameter  so  as  to  fit  an  ordinary 
watch  key  or  wrench  and  should  not  be  less  than  -jg  of  an 
inch  in  length  in  order  to  have  a  good  hold  and  resist  the 
necessary  strain.  When  greater  strain  than  ordinary  is  to 
be  withstood,  they  should  be  made  longer  to  prevent 
stripping  of  the  thread.  They  may  be  made  from  a  nickel 
five-cent  piece  by  filing  it  smooth  on  both  sides,  marking 
into  squares  of  proper  size,  centering,  drilling  and  tapping 
each  one  and  then  sawing  them  apart,  as  recommended  by 
Dr.  Case ;  or  they  may  more  conveniently  be  made  from 
heavy,  square,  German  silver  tubing,  by  sawing  it  into 
sections,  grasping  these  in  the  pin-vise  (b)  and  then  drilling 
and  tapping  them. 

In  using  the  tap  to  cut  the  threads  on  the  inside  of  these 
nuts,  it  should  be  held  in  a  suitable  holder  and  fed  carefully 
with  an  alternate  forward  and  backward  movement  to  avoid 
clogging  and  danger  of  breaking  the  highly  tempered 
tool. 

The  taps  and  dies  are  always  marked  with  the  same 
numbers  so  that  the  corresponding  ones  can  be  used 
in  each  case.  If  the  tubing  from  which  the  nuts  are  to  be 
made  has  not  been  soldered  after  being  drawn,  it  should  be 
before  it  is  cut  into  sections. 

*  German  silver  wire  of  any  size  can  be  procured  at  electrical  supply 
houses.  The  size  best  adapted  for  jack-  and  traction-screws  is  No.  17,  (B.  & 
S.)  corresponding  to  hole  No.  17  in  the  Joubert  draw-plate.  This  wire  is  of 
just  the  proper  diameter  to  be  thread-cut  in  the  third  smallest  hole  of  Stub's 
screw-plate  [1). 


PRACTICAL    TREATMENT. 


221 


Comparative  Table, 


Showing  Sizes  of  Wire  and  Plate  in  Decimals  of  an  Inch  ijy  Vaei- 
ors  Wire  Gauges. 


No.  of 

English 

Stub's  and 

American  Standard 

Gauge. 

Standard. 

Birmingham. 

or 
Brown  &  Sharpe. 

0000 

.454 

.454 

.460 

000 

.425 

.425 

.40964 

00 

.380 

.380 

.36480 

0 

.340 

.340 

.32495 

1 

.300 

.300 

.28930 

2 

.284 

.284 

.2.5763 

3 

.259 

.259 

.22942 

4 

.238 

.238 

.20431 

5 

220 

.220 

.18194 

6 

.203 

.203 

.16202 

7 

.180 

.180 

.14428 

8 

.165 

.165 

.12849 

9 

.148 

.148 

.11443 

10 

.134 

.134 

.10189 

11 

.120 

.120 

.09074 

12 

.109 

.109 

.08081 

13 

.095 

.095 

.07196 

14 

.083 

.083 

.06408 

15 

.072 

.072 

.05706 

16 

.065 

.065 

.05082 

17 

.058 

.058 

.04525 

18 

.049 

.049 

.04030 

19 

.040 

.042 

.03589 

20 

.035 

.035 

.03196 

21 

.0315 

.032 

.02846 

22 

.0295 

.028 

.02534 

23 

.027 

.025 

.02257 

24 

.025 

.022 

.0201 

25 

.023 

.020 

.0179 

26 

.0205 

.018 

.01594 

27 

.01875 

.016 

.01419 

28 

.0165 

.014 

.01264 

29 

.0155 

.013 

.01125 

30 

.01375 

.012 

.01002 

•   31 

.01225 

.010 

.00892 

32 

.01125 

.009 

.00795 

33 

.01025 

.008 

.00708 

34 

.0095 

.007 

.0063 

35 

.009 

.005 

.00561 

36 

.0075 

.004 

.005 

In  explanation  of  the  above  table  it  may  be  stated  that 
the  numbers  in  the  first  column  refer  to  the  numbers  on 
the  various  gauge-j^lates,  and  their  respective  equivalents,  in 


222  ORTHODONTIA. 

decimals  of  an  inch,  will  be  found  in  one  of  the  other 
columns.  Thus  No.  17  of  the  B.  &  S.  gauge  is  equal  to 
.04525  of  an  inch,  while  No.  17  of  the  English  standard  is 
equal  to  .058,  or  a  trifle  more  than  .010  greater  than  that  of 
the  B.  &  S. 

So  also  No.  18  of  either  the  Stub's  or  English  gauge  is 
nearly  the  same  as  No.  17  of  the  B.  &  S. 


CHAPTER  VI. 


ELECTRO-PLATING. 


Electro-plating  is  the  art  of  precipitating  certain  metals 
from  their  solutions  by  the  slow  action  of  a  galvanic  current. 
By  this  process  the  salts  of  the  metals  in  solution  are  decom- 
posed, the  metal  being  deposited  upon  the  object  to  be  plated 
at  the  negative  pole  while  acid  is  liberated  at  the  positive 
one.  Electro-gilding,  or  plating  with  gold,  is  employed  in 
dentistry  chiefly  for  the  pur[)0se  of  giving  to  appliances  made 
from  the  baser  or  oxidizable  metals  a  coating  of  finer  metal 
(gold)  that  will  resist  the  action  of  the  fluids  of  the  mouth. 

Regulating  appliances  made  from  German  silver  or 
steel,  in  whole  or  in  part,  not  only  present  a  better  appear- 
ance, but  endure  longer  and  operate  more  satisfactorily  when 
properly  gilded. 

Piano-wire,  so  valuable  and  so  largely  employed  in  con- 
nection with  regulating  devices,  not  only  becomes  unsightly, 
but  deteriorates  when  worn  for  a  long  time  in  the  mouth. 
It  may  be  bought  electro-gilded,  but  the  coating  is  so  thin 
as  not  to  be  durable. 

German  silver,  which  is  rapidly  growing  in  favor  for  the 
construction  of  regulating  appliances  on  account  of  its  inex- 
pensiveness  and  intrinsic  merits,  is  also  readily  acted  upon 
by  the  fluids  of  the  mouth  and  the  resultant  oxidation 
greatly  interferes  with  the  operation  of  nuts  and  screws  or  the 
play  of  wires  in  their  neatly  fitting  tubes.  Gilding  obviates 
all  of  these  disadvantages  and  gives  us  the  virtue  of  gold 
without  its  expensiveness. 

German  silver  is  easily  gilded  in  either  a  warm  or  cold 
bath  if  its  surface  be  first  thoroughly  cleansed,  but  steel, 
owing  to  its  ready  oxidability  in  the  cleansing  bath,  does 

223 


224  ORTHODONTIA. 

not  receive  a  good  and  durable  coating  of  gold  unless  it  is 
first  plated  with  copper.  Steel  therefore  requires  to  be 
subjected  to  two  processes,  while  German  silver  or  other 
alloys  of  copper  need  but  one.  Each  of  these  processes  will 
be  described. 

As  a  preliminary  to  plating,  all  articles  must  have  a 
perfectly  clean  surface,  otherwise  the  deposit  will  not  adhere 
firmly  to  the  object  receiving  it  and  the  durability  of  the 
coating  be  greatly  lessened. 

During  both  processes  of  cleansing  and  plating,  the  article 
must  not  be  touched  with  the  fingers,  as  the  slightest  contact 
will  prevent  the  adhesion  of  the  metal  at  such  points.  To 
prevent  this  the  article  to  be  plated  should  have  a  copper  or 
platinum  wire  attached  to  it  at  some  point  by  means  of 
which  it  must  always  be  handled  until  the  entire  operation 
is  completed. 

CLEANSING    GERMAN    SILVER,    BRASS    AND    OTHER 
COPPER    ALLOYS. 

The  following  is  one  of  the  best  formulae  for  a  cleansing 
solution : 

Caustic  potash,  .  .  .  .  .  1  lb. 

Water,  (soft)  .....  1  gal. 

Heat  nearly  to  boiling  point  in  a  glass,  porcelain  or 
porcelain-lined  dish,  and  suspend  the  article  for  a  few 
minutes  in  the  hot  solution. 

Remove  and  brush  thoroughly  upon  a  board,  after  which 
rinse  well  in  clean  water.  If  the  article  is  soft-soldered  at 
any  point  it  must  not  remain  in  the  lye  too  long  or  the  solder 
will  be  acted  ujDon. 

CLEANSING    STEEL. 

Dip  in  the  caustic  lye  used  for  copper,  rinse  thoroughly, 
scour  with  moistened  pumice,  rinse  again  and  pass  through 
the  following  dip : 

Sulphuric  acid,       .....  1  part. 

Water,        ......  W  parts. 


PRACTICAL    TREATMENT.  225 

After  this  the  article  must  again  be  well  rinsed  before 
being  placed  in  the  plating  batli. 

COPPER    SOLUTION. 

The  electro  deposit  of  copper  is  usually  obtained  by  the 
decomposition  of  acetate  of  copper  and  cyanide  of  potassium. 
A  good  bath  or  solution  is  as  follows : 


Water,  (soft) 


Igal. 


Acetate  of  copper,  (crystals)  ...  31  ozs. 

Carbonate  of  soda,   (crystals)  ...  3^  ozs. 

Bisulphite  of  soda,  ....  3  ozs. 

Cyauide  of  potassium,  (pure)  ...  7|  ozs. 

Moisten  the  copper  salt  with  water  to  form  a  paste,  (other- 
wise it  is  apt  to  float  on  the  liquid) ;  stir  in  next  the  carbonate 
of  soda  with  a  little  more  water,  then  the  bisulphite,  and 
finally  the  cyanide  with  the  rest  of  the  water. 

When  solution  is  complete,  the  liquid  should  be  nearly 
colorless. .  If  not,  add  cyanide  until  it  is. 

This  bath  may  be  used  either  hot  or  cold. 

An  immersion  of  a  few  minutes  will  usually  furnish  a 
sufficient  coating  of  copper  when  the  article  is  afterward  to 
be  gilded. 

GOLD    SOLUTION. 

Formula : 

Chloride  of  gold,  .  .  .  ..  72  grs. 

Cyanide  of  potassium,  (pure)      ...  1 J  ozs. 

Water,  (distilled)  ....  30  ozs. 

Dissolve  the  cyanide  in  part  of  the  water,  then  gradually 
add  the  gold  chloride*  dissolved  in  the  remainder.  Boil  for 
one-half  hour  and  use  cold.  The  solution  prepared  as  above 
should  be  colorless  after  standing  awhile,  and  the  color  of 
the  deposit  should  be  yellow.  If  black  or  dark  red,  add 
more  cyanide  dissolved  in  water.  If  cyanide  be  in  excess, 
plating  will  proceed  slowly  or  not  at  all ;  in  such  case  add 
more  gold  chloride  or  increase  intensity  of  current  by  im- 
*  Chloride  of  gold  can  be  purchased  at  chemical  supply  houses. 


226 


ORTHODONTIA. 


mersing  zincs  deeper  in  cell.  In  gilding  German  silver,  the 
best  results  are  obtained  when  the  bath  is  kept  slightly 
warm. 

All  gilding  baths  should  be  stirred  occasionally  to 
destroy  the  gravity  of  the  liquids. 

BATTERY. 

For  small  articles,  such  as  regulating  appliances,  a  single 
cell  (Daniel  or  Smee)  will  give  us  sufficient  intensity  of 
current. 

Fig.  164  represents  a  simple  battery  composed  of  a  single 
Smee  cell  connected  with  the  jar  containing  solution  and 
articles  to  be  plated.* 

In  the  illustration  Fig.  164. 

of  the  battery,  "  z " 
represents  the  zinc 
plates  and  "  s  "  a  strip 
of  platinized  silver 
suspended  between 
them.  "  ^o "  is  a 
wooden  support 
which  rests  upon  the 
edges  of  the  jar  with 
the  silver  strip  let  into 
its  under  surface.  "  6  "  is  a  clamp  connecting  the  two  zinc 
plates  on  the  outside  of  the  wooden  support,  while  clamp  "a" 
connects  with  the  silver  strip.  The  plating  or  bath  jar  has  two 
copper  rods  resting  upon  it,  one  of  which  "  d  "  has  the  metal 
anode  suspended  from  it  by  means  of  a  platinum  or  copper 
wire,  while  the  other  "  c  "  has  the  cathode  or  article  to  be 
plated  similarly  suspended. 

The  battery  jar  or  cell  is  charged  with  a  solution  of  one 
part  of  sulphuric  acid  to  ten  parts  of  water.      The  current 

*  A  Smee  cell  with  platinized  silver  plate  can  be  bought  at  any  electrical 
supply  house  for  $3.50,  and  additional  plain  glass  jars,  one  for  copper  and 
the  other  for  gold  solution,  for  about  15  cents  each. 


Plating  Battery. 


PRACTICAL    TREATMENT.  227 

generated  by  the  action  of  the  acid  solution  upon  the  zinc 
plates  passes  through  the  positive  (+)  wire  to  the  rod  "  d," 
into  the  plating  solution  by  way  of  the  anode  (/),  across  to 
the  cathode  (e)  and  back  to  the  battery  by  way  of  the 
negative  wire  ( - ).  The  current  in  its  passage  decomposes  a 
portion  of  the  gilding  solution  and  causes  the  metal  thus 
set  free  to  be  attracted  to  and  deposited  upon  the  article  to 
be  plated. 

The  solution  being  thus  deprived  of  a  portion  of  its  con- 
stituent salt,  in  turns  acts  upon  the  suspended  anode  and 
takes  from  it  a  sufficiency  of  the  metal  to  restore  its  former 
equilibrium.  In  this  way,  as  each  article  is  coated  with  the 
metal,  the  suspended  anode  is  eaten  away  to  replace  the  loss 
and  the  solution  suffers  no  great  diminution  of  strength. 
The  anode  for  copper  plating  consists  of  a  piece  of  sheet 
copper,  while  for  gilding,  the  anode  should  be  of  pure  gold 
and  can  be  made  by  melting  gold  foil  scraps  into  a  button 
and  then  hammering  it  into  a  thin  sheet.  All  anodes  should 
have  perfectly  clean  surfaces  in  order  that  they  may  be 
readily  acted  upon. 

PLATING. 

With  the  battery  in  position  and  the  jars  filled  to  within 
about  two  inches  of  their  tops  with  their  respective  liquids, 
the  operation  of  plating  is  a  very  simple  one.  After  the 
article  to  be  plated  has  been  made  smooth  and  polished  and 
properly  cleansed  in  the  cleansing  solution,  it  is  rinsed  in 
water,  and  if  other  than  steel,  is  immediately  suspended  in 
the  plating  solution  from  the  copper  rod  "  c."  The  corres- 
ponding anode  is  hung  upon  the  other  rod  "  d,"  when  the 
deposit  of  metal  at  once  begins.  The  length  of  time 
necessary  to  secure  a  good  coating  will  vary  somewhat  with 
the  strength  of  the  solution,  the  intensity  of  the  current  and 
th-e  metal  to  be  plated.  Usually  from  ten  to  twenty 
minutes  will  be  sufficient,  but  a  little  practice  will  be  neces- 
sary to  determine  the  time  and  secure  the  best  results.     If 


228  ORTHODONTIA. 

on  removal  the  deposit  is  found  to  be  too  light,  the  article 
can  again  be  placed  in  the  bath  and  more  added.  When 
finally  removed  from  the  bath  it  should  be  held  in  running 
water  and  then  dried. 

If  the  article  has  a  dead  finish  when  placed  in  the  bath, 
it  will  present  a  similar  appearance  when  plated.  If  polished 
in  the  first  instance,  the  deposit  will  have  a  polished  appear- 
ance provided  the  current  be  not  too  strong. 

The  process  of  plating  steel  differs  from  the  one  just 
described  in  requiring  the  article  to  be  dipj)ed  for  a  moment 
in  the  sulphuric  acid  solution  after  it  comes  from  the 
cleansing  solution  and  before  it  is  placed  in  the  copper  plat- 
ing bath.  After  receiving  a  fair  coating  of  copper  it  is 
washed  and  then  placed  in  the  gold  bath  and  gilded  as 
described. 

The  deposition  of  the  metal  in  any  case  usually  progresses 
more  quickly  and  evenly  when  the  article  to  be  plated  is 
separated  by  about  two  inches  from  the  anode  and  is  slightly 
agitated  while  in  the  bath. 

When  the  battery  is  not  in  use  the  anode  should  be  re- 
moved from  the  plating  solution  and  the  zincs  be  elevated 
above  the  liquid  in  the  battery.  Both  jars  should  also  be 
covered  to  protect  them  from  dust. 


RK621 

Guilford 

Orthodontia. 


G94 

1893 
cop.l 


h^Mw^TEik'Sl^ii^" 


